Effect of vericiguat on echodynamics and myocardial remodeling in patients with heart failure with reduced ejection fraction
C Carbonaro, P P Bocchino, G Galli, G Gallone, G Gobello, F Angelini, C Griffith Brookles, E Bertello, S Pidello, G De Lio, F Ravera, C Raineri, G M De FerrariAbstract
Introduction
Vericiguat was demonstrated to reduce cardiovascular death and heart failure (HF) hospitalizations in high-risk patients with HF with reduced ejection fraction (HFrEF). We aimed to evaluate the effect of vericiguat on non-invasive haemodynamics (‘echodynamics’) and remodeling parameters following its initiation in HFrEF patients.
Methods
This was a prospective single-center observational study conducted within the HF Registry on consecutive HFrEF patients who initiated vericiguat according to current guidelines and completed a 6-month follow-up alive until January 2025. The primary endpoint was the change in echodynamics, defined as echocardiographic surrogates of left ventricular (LV) systolic function, stroke volume, filling pressures and pulmonary pressures. Vericiguat responders were defined as patients showing significant improvement in LVEF (absolute increase >2%), LV outflow tract VTI (>1.0 cm) and/or E/e’ ratio (absolute decrease >1.0) without concomitant worsening of the other two parameters.
Results
113 patients were included (mean age: 63.7±10.7 years; 95 [84.1%] male; median N-terminal pro B-type natriuretic peptide [NT-proBNP] levels: 1433 pg/mL [IQR 776–2905 pg/mL]; mean LVEF: 28.0±7.5%). At 6-month follow-up, a statistically significant increase in LVEF (from 28.0±7.5% to 29.8±8.0% , p=0.002) and LV outflow tract VTI (from 16.0±3.4 to 16.8±4.1 cm, p=0.009), and a significant decrease in E/e’ ratio (from 13.3±5.3 to 11.9±5.1, p=0.036) were observed, with no significant changes in pulmonary artery systolic pressure. Vericiguat responders showed significantly lower rates of a composite of clinical events (all-cause death, heart transplantation, LVAD implant, HF hospitalization or outpatient HF worsening) (log-rank p= 0.013).
Conclusion
In patients with HFrEF receiving optimized medical therapy, the addition of vericiguat significantly improves non-invasive indices of stroke volume and filling pressures, alongside systolic function. Future studies are warranted to validate these findings.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.