Role of vericiguat on renal function decline in patients with worsening heart failure
G Armentaro, G Severini, M R Scarcelli, C A Pastura, V Cassano, V Condoleo, S Miceli, A SciacquaAbstract
Background/Introduction
Heart failure (HF) is a public health problem, especially in patients with several comorbidities such as chronic kidney disease (CKD). In fact, CKD, besides being one of the main comorbidities of HF patients, worsens their quality of life, prognosis and complicates their therapeutic management. In this context, Vericiguat could represent an additional therapeutic option, however, to date, we have no data on the trajectories of renal function in patients with a recent episode of wHF in treatment with vericiguat, for a long term follow-up.
Purpose
The aim of the present study was to evaluate the potential effects of a twenty-four-month continuous treatment with Vericiguat in addition to optimised medical therapy (OMT) on the rapid decline in renal function (RDRF); defined as an annual loss of eGFR ≥5 ml/min/1.73 m2 in a cohort of wHF patients. The group on therapy with Vericiguat was compared to a control group on therapy with the four pillars of HF with reduced ejection fraction.
Methods
One hundred and twenty-three patients with wHF (100 men and 23 women, mean age 68.3±10.6 years) were enrolled. 63 patients in treatment with Vericiguat and 60 for the other group. Patients underwent clinical-instrumental, laboratory and echocardiographic evaluation at baseline and every six months for a total follow-up of twenty-four months. For the analysis of unpaired data, Student's t-test or Wilcoxon's test, as appropriate, was used to compare study variables at baseline. Finally, a logistic regression model was constructed on the RDFR.
Results
The two groups were overlapping in terms of sex, age, major comorbidities and therapies, but differed in the prevalence of diabetes and dyslipidaemia which was higher in the control group (p<0.05), and the presence of ICD/CRTd which was higher in the vericiguat-therapy group (p<0.05). After 24 months, 38 renal events (60%) occurred, of which 11 in the vericiguat-therapy group and 27 in the other group (p=0.0009). The logistic regression model showed that vericiguat therapy was associated with a 75% reduction in the risk of RDRF (OR 0.258, 9% CI 0.106-0.629; p=0.003). On the other hand, male gender was associated with a 7.8-fold increased risk of RDRF (OR 7.823; 95% CI 1.550-39.48, p=0.013), and age 10 years of age by 52% (OR 1.528, 95% CI 1.341-1.818, p=0.004). Of particular interest, during follow-up, a greater reduction in furosemide dosage was observed in the vericiguat therapy group than in the control group (-48 vs. - 25 mg/day, p<0.05).
Conclusions
This is the first study conducted in an HFrEF population with several comorbidities and a recent episode of wHF, in which the addition of vericiguat, in patients already treated with OMT, resulted in a 75% reduced risk of RDRF compared to the control group. In addition, a greater and significant reduction in furosemide dosage was observed in the vericiguat-treated group compared to the control group.