Vericiguat 5mg initiation in Asian HFrEF patients showed 98.5% up-titration success to 10mg, 43.9% BNP reduction at Day 14, and 14.6% LVEF improvement at Week 20.
Does initiating vericiguat at 5mg and up-titrating to 10mg safely improve hemodynamics, biomarkers, and echocardiographic outcomes in Chinese HFrEF patients on optimized GDMT?
Initiating vericiguat at 5mg and up-titrating to 10mg is safe and well-tolerated in Chinese HFrEF patients on optimized GDMT, leading to rapid improvements in BNP and LVEF.
Abstract Background Despite advancements in guideline-directed medical therapy (GDMT), residual risk persists in heart failure with reduced ejection fraction (HFrEF)1. Vericiguat, a soluble guanylate cyclase stimulator, improves outcomes2,3 but raises safety concerns during dose up-titration, particularly in understudied Asian populations4. Purpose To evaluate the safety and efficacy of initiating vericiguat at 5mg and up-titrating to 10mg in Chinese HFrEF patients receiving optimized GDMT, focusing on hemodynamic tolerance, biomarker changes, and echocardiographic outcomes. Methods The study was a single-center, prospective, single-arm, self-controlled cohort of 140 Chinese patients with HFrEF ) (LVEF 45%, NYHA II-IV) receiving optimized GDMT. 7 patients were excluded: one was died of sudden cardiac death after 1 month, two were self-withdrawal due to dizzy, two were refused to continue medication for personal reasons and 2 were discontinued due to difficulty going to the hospital. After 4-week GDMT stabilization (ARNI: 88%, SGLT2i: 92%, beta-blockers: 96%, MRA: 93%), vericiguat was initiated at 5mg for the else 133 patients with up-titration to 10mg at Day 14 if tolerated. Serial assessments included hemodynamics, biomarkers (BNP), and echocardiography at baseline, Week 12, and Week 20. Results Of 133 patients completing baseline assessment (mean age 61.5±14.2, 75% male, LVEF 34.8±8.5%) (Table 1), 98.5% (131/133) successfully up-titrated to vericiguat 10mg. Key findings: Safety: No significant hypotension (Day 1 SBP: 122.7±14.9 vs. baseline 125.5±22.4 mmHg, p=0.12) or renal/hepatic toxicity on Day 14 (Fig. 1, A-E). Two patients discontinued due to dizziness (1 with baseline SBP 100 mmHg). (Fig. 1) Efficacy: BNP decreased by 43.9% at Day 14 (721.8±861.8 vs. 1286.6±1078.3 pg/mL, p0.001) (Fig. 1, F). LVEF improved progressively (+8.1% at Week 12, +14.6% at Week 20 vs. baseline, both p0.001), with LVDD reduction of 4.4% at Week 20 (p0.05) (Fig. 1, G-H). GDMT synergy: Quadruple therapy utilization (78.9%) at baseline exceeded Western cohorts (15.3-25%)5,6, potentially enhancing vericiguat’s tolerability. Conclusions Vericiguat 5mg initiation demonstrated exceptional safety and rapid hemodynamic benefits in Asian HFrEF patients, with 98.5% achieving target dosing. The observed cGMP-NP pathway synergy with high-intensity GDMT supports early vericiguat integration in optimized treatment regimens for Asian populations.Figure. 1 Table. 1
Wang et al. (2025) studied this question. Vericiguat 5mg initiation in Asian HFrEF patients showed 98.5% up-titration success to 10mg, 43.9% BNP reduction at Day 14, and 14.6% LVEF improvement at Week 20.