Assessment of venous congestion in HFrEF using VExUS in a cohort of patients treated with Vericiguat
A D'Amato, F Ferranti, G Cusumano, C Brigato, R Cascone, F Giovagnoli, V Colella, C Segato, R Germano', S Marcon, R Badagliacca, C D Vizza, A Gigante, P SeverinoAbstract
Background
In patients with heart failure with reduced ejection fraction (HFrEF) and recent worsening despite guideline-directed medical therapy (GDMT), vericiguat has been shown to reduce adverse cardiovascular events. In this setting, multiparametric ultrasound assessment of systemic venous congestion (VExUS) enables a more objective quantification of congestion burden and monitoring of changes over time. The primary endpoint of this study was to assess changes in ultrasound parameters of VExUS from baseline to 6-month follow-up after initiation of vericiguat in patients with worsening HFrEF. The secondary endpoint was to identify potential predictors of intrarenal venous flow patterns and to explore the possible role of vericiguat in this context.
Methods
In this single-center prospective observational study, patients eligible for vericiguat were enrolled; each patient underwent baseline (T0) and 6-month follow-up (T1) assessments after treatment initiation, including clinical, biomarker, and VExUS evaluation (inferior vena cava, lung B-lines, jugular venous distension, hepatic veins, and intrarenal venous flow), along with measurement of the renal resistive index (RRI).
Results
42 consecutive patients (mean age 72.5 ± 9.7 years; 8 female) eligible for vericiguat were enrolled. At follow-up, intrarenal venous flow (IRVF) was the only VExUS parameter showing a statistically significant improvement (p=0.021). In a multivariate mixed-effects logistic regression model, vericiguat therapy and higher estimated glomerular filtration rate (eGFR) values were independently associated with a higher probability of continuous IRVF (p<0.001), whereas baseline RRI ≥0.70 and abnormal hepatic venous flow patterns were independently associated with discontinuous IRVF (p<0.001).
Conclusions
IRVF emerged as the most sensitive VExUS marker and the parameter most responsive to vericiguat in worsening HFrEF. Continuous IRVF was associated with better baseline renal function, while RRI ≥0.70 and abnormal hepatic venous Doppler patterns predicted discontinuous flow. These findings suggest a potential cardiorenal hemodynamic benefit of vericiguat.