The hemodynamic effect of vericiguat during exercise right heart catheterization in patients with HFrEF
G Velissaris, M Pentaris, N Biagkis, S Mykoniati, Z Morou, M Tselegkidi, D Chatzis, A Dimoula, K Bratis, S Chatzidou, N Papaioannou, S Papaioannou, T Kallis, G Tomazou, A NtalianisAbstract
Background
Vericiguat reduces the risk of cardiovascular death and hospitalization for heart failure in patients with HFrEF and recent decompensation. However, its effects in hemodynamics and especially during exercise are still unknown
Purpose
To investigate the hemodynamic effects of vericiguat during exercise right heart catheterization (ERHC) in patients with HFrEF.
Methods
Symptomatic patients with HFrEF (NYHA II-IV) were randomly assigned to vericiguat (V) or optimal medical treatment (C). ERHC was performed via the right jugular vein with a 7F Swan-Ganz catheter before and 1 year after randomization in both groups. A controlled 6 minute exercise protocol with a supine cycle ergometer was implemented. Hemodynamics and venous blood from the pulmonary artery (PA) for gas analysis before and every minute of exercise were obtained. In the V group, vericiguat was initiated at a dose of 2.5 mg o.i.d and up-titrated during a period of 3 weeks to reach the maximally tolerated dose (the target dose was 10 mg o.i.d).
Results
Fourty patients with HFrEF (mean age: 68y, NYHA: 2.7±0.6, Ejection fraction: 28±9%) were included. Both groups were well balanced and no difference in baseline characteristics was observed. In total 5 patients deceased (4 in the V group and 1 in the C group). No significant changes of the ejection fraction, NYHA class, rest (Figure 1) and exercise hemodynamics (Figure 2) were observed in both groups.
Conclusions
The effect of vericiguat in ERHC hemodynamics is neutral in patients with HFrEF. Thus, the clinical benefit anticipated by vericiguat could be attributed to more complex pathophysiological mechanisms which do not primarily affect ERHC hemodynamics.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.