Combined sacubitril/valsartan plus vericiguat therapy provided a significantly greater improvement in left ventricular ejection fraction at 1 year compared with vericiguat alone (p=0.01).
Observational
Does combined sacubitril/valsartan plus vericiguat therapy improve left ventricular function compared to either therapy alone in patients with heart failure with nonpreserved ejection fraction?
In a real-world setting, adding vericiguat to sacubitril/valsartan provides incremental benefits in improving left ventricular ejection fraction in patients with heart failure with nonpreserved ejection fraction.
p-value: p=0.01
Background Vericiguat and sacubitril/valsartan both modulate the nitric oxide–soluble guanylate cyclase–cyclic guanosine monophosphate signaling pathway and may improve myocardial function in patients with heart failure. Objectives To compare the effects of vericiguat, sacubitril/valsartan, and their combination on left ventricular function and clinical outcomes in heart failure with nonpreserved ejection fraction patients. Methods In this retrospective real-world study, patients were classified into three groups: vericiguat added to guideline-directed medical therapy (vericiguat group), sacubitril/valsartan-based therapy (sacubitril/valsartan group), and combined sacubitril/valsartan plus vericiguat therapy (add-vericiguat group). Changes in left ventricular ejection fraction (ΔLVEF), in stroke volume (ΔSV), and in log-transformed N-terminal pro–B-type natriuretic peptide (ΔLog 10 NT-pro BNP) from baseline to 1 year were evaluated. Clinical outcomes were also assessed. Results At 1 year, LVEF significantly improved in both the vericiguat group ( p = 0.02) and the sacubitril/valsartan group ( p < 0.001). There was no significant difference in ΔLVEF between these two groups ( p = 0.25). In contrast, the add-vericiguat group demonstrated a significantly greater improvement in ΔLVEF compared with the vericiguat group ( p = 0.01). Conclusions In a real-world setting, vericiguat was associated with improvements in left ventricular function comparable to those of sacubitril/valsartan, and combination therapy provided incremental benefits. Vericiguat may serve as an alternative or adjunctive treatment option, particularly in patients unable to tolerate or maintain angiotensin receptor–neprilysin inhibitor therapy.
Kinoshita et al. (Sat,) conducted a observational in Heart failure with nonpreserved ejection fraction. Combined sacubitril/valsartan plus vericiguat therapy vs. Vericiguat added to guideline-directed medical therapy or sacubitril/valsartan-based therapy was evaluated on Change in left ventricular ejection fraction (ΔLVEF) from baseline to 1 year (p=0.01). Combined sacubitril/valsartan plus vericiguat therapy provided a significantly greater improvement in left ventricular ejection fraction at 1 year compared with vericiguat alone (p=0.01).