Abstract 15501: Effects of Vericiguat on Right Ventricular Function in Chronic Heart Failure Patients

Introduction: Despite the beneficial clinical effects of vericiguat in chronic heart failure, the potential effects of vericiguat therapy on right ventricular (RV) function remain poorly defined.

Hypothesis: We sought to evaluate the effects of vericiguat on RV function in chronic heart failure patients.

Methods: We performed a prospective non-randomized single center study enrolling 24 consecutive HFrEF outpatients who were receiving stable heart failure therapy for at least 3 months. All patients received vericiguat 2,5 mg qd at baseline and up-titration was performed on a bi-weekly basis to the target dose of 10 mg qd. At baseline and at 3 month follow-up all patients underwent clinical, biochemical and echocardiographic evaluation. Improved RV function was defined as any improvement in TAPSE between baseline and 3 months.

Results: During follow-up we observed a significant overall improvement of TAPSE (18.5±4.2 mm vs. 21.3±4.7 mm; P=0.03) and TR gradient (35±10 mmHg vs. 29±8 mmHg; P=0.04). RV function improved in 17 patients (70%; Group A) and remained unchanged in 7 (30%) patients (Group B). At baseline, the two groups did not differ in gender (male; 100% in Group A vs. 90% in Group B; P=0.37), age (64±9 years vs. 61±9 years; P=0.59), NYHA class (2.9±0.5 vs. 3.1± 0.3; P=0.39), or heart failure etiology (ishemic: 64% vs. 71%; P=0.76). Heart failure therapy was also comparable: ARNI (94% vs. 100%; P=0.53), beta blockers (94% vs. 100%; P=0.53), MRA (100% vs. 100%), SGLT2i (100% vs. 86%; P=0.12) and loop diuretics (59% vs. 57%; P=0.94). We found no differences in baseline LVEF (30±6% vs. 29±4%; P=0.73), LVOT VTI (15±3 cm vs. 14±5 cm; P=0.34), LVEDV (219±51 mL vs. 197±56 mL; P=0.39), TAPSE (17±3 mm vs. 18±3; P=0.68), RVIDd (39±4 mm vs. 38±3 mm; P=0.58) and TR gradient (34±8 mmHg vs. 38±11 mmHg; P=0.38). Both groups received similar doses of vericiguat (8.5±2.8 mg in Group A vs. 6.8±2.9 mg in Group B; P=0.19). Compared to Group B, we found significantly lower baseline NT-proBNP serum levels in Group A (1888±1973 pg/mL vs. 6373±5465 pg/mL; P=0.009).

Conclusions: Vericiguat therapy may be associated with improved RV function in chronic heart failure patients. The effects appear to be particulary pronounced in patients with lower NT-proBNP levels.