Vericiguat treatment was significantly associated with a ≥30% reduction in NT-proBNP levels (HR 2.54) in HFrEF patients with asymptomatic hypotension receiving guideline-directed medical therapy.
Cohort (n=97)
Yes
Does vericiguat improve NT-proBNP reduction in patients with HFrEF and asymptomatic hypotension receiving guideline-directed medical therapy?
Vericiguat safely and significantly reduces NT-proBNP levels in HFrEF patients with asymptomatic hypotension who are already receiving optimized guideline-directed medical therapy.
Hazard Ratio: 2.54 (95% CI 1.42–4.55)
Absolute Event Rate: 68.8% vs 47.2%
p-value: p=<0.001
Background Recent VICTOR study and the VICTORY pooled analysis demonstrate that vericiguat shows significant therapeutic value in a broader population of relatively stable heart failure with reduced ejection fraction (HFrEF) patients. However, the efficacy and safety of vericiguat in HFrEF patients receiving guideline-directed medical therapy (GDMT) who present with asymptomatic hypotension (systolic blood pressure (SBP) ≤ 100 mmHg) remain unclear and require further investigation. Methods This multicenter observational cohort study enrolled 164 patients with HFrEF and asymptomatic hypotension (SBP ≤ 100 mmHg), who voluntarily decide whether to receive vericiguat treatment. Propensity score matching (1:2) was employed to address non-random treatment allocation. The primary outcome was the first occurrence of a ≥ 30% reduction in N-terminal pro-B-type natriuretic peptide(NT-proBNP) from baseline at any assessment time point during follow-up. Kaplan-Meier (K-M) analysis and multivariable Cox regression models were applied to assess outcomes. Results A total of 61 vericiguat-treated patients and 36 controls completed the study. The incidence of significant NT-proBNP reduction in the vericiguat group was 68.8%, significantly higher than the 47.2% in the control group. Kaplan-Meier analysis demonstrated a significantly higher cumulative incidence of NT-proBNP reduction in the vericiguat group than in the control group (hazard ratio (HR) = 2.54, 95% confidence interval (CI): 1.42–4.55, P < 0.001). Multivariate Cox regression confirmed vericiguat as an independent predictor of significant NT-proBNP reduction (Model 3: HR = 2.34, 95% CI: 1.30–4.21, P = 0.004). Conclusion In patients with HFrEF receiving GDMT with concomitant asymptomatic hypotension (SBP ≤ 100 mmHg), vericiguat treatment is significantly associated with a ≥ 30% reduction in NT-proBNP levels during follow-up. In terms of safety in this study, the small number of adverse events and the absence of major safety signals only suggest no statistically significant differences in safety between the two groups. Further large-scale studies with adequate statistical power are required to better evaluate the safety of vericiguat. Graphical abstract
Directly relevant to VICTOR/VICTORIA trial discussions; shared in HF specialist networks; observational data fills gap for real-world use.
Tian et al. (Wed,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) and asymptomatic hypotension (n=97). Vericiguat vs. Standard guideline-directed medical therapy (GDMT) without vericiguat was evaluated on First occurrence of a ≥30% reduction in NT-proBNP from baseline (HR 2.54, 95% CI 1.42-4.55, p=<0.001). Vericiguat treatment was significantly associated with a ≥30% reduction in NT-proBNP levels (HR 2.54) in HFrEF patients with asymptomatic hypotension receiving guideline-directed medical therapy.
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