Effect of Vericiguat on Pulmonary Artery Pressures in Heart Failure Patients: Real-World Insights from Pressure Sensor Monitoring

Vericiguat improves outcomes in heart failure (HF) by promoting vasodilation of the systemic and pulmonary arterial beds. Little is known about its impact on pulmonary artery pressure (PAP). We aimed to study this effect using measurements from implanted PAP sensors. A retrospective analysis of HF patients treated with vericiguat and implanted with CardioMEMS. PAP was followed for 90 days before and after vericiguat initiation. We recorded labs, echocardiographic and hemodynamics prior to vericiguat initiation. Fifteen patients were included (age 70, 67% men). At baseline, median EF was 27.5%, 42% had RV dysfunction, mildly elevated mean PAP (24 mmHg) and pulmonary vascular resistance of 1.6 Wood. When comparing the average of measurements 90 days before and after vericiguat, there were no changes in systolic (34(28-42) vs 33(30-40), p=0.4), diastolic (17(14-20) vs 16(13-20), p=0.75), and mean (24(18-28) vs 23(19-28), p=0.55) PAP. We compared average measurements in the 3-week period prior to starting vericiguat to various 3-week intervals after vericiguat and found no difference. At 90 days the median loop diuretic dose (Furosemide equivalent) was 40mg [0-160], compared to 42mg [0-240] prior to vericiguat. NTproBNP did not changed significantly before and after vericiguat initiation (log(NTproBNP) 3.1(2.4-3.2) vs 2.9(2.5-3.1), p=0.4). In conclusion, vericiguat was well tolerated in stable HF patients with mild pulmonary hypertension, but no significant effect on PAP was observed. Larger studies, including patients with higher PAP, are needed to clarify its impact.