Vericiguat treatment in symptomatic HFrEF patients increased flow-mediated dilation from 4.7% to 6.9% (P=0.015) and improved resting cardiac output and systemic vascular resistance.
Does vericiguat improve peripheral vascular function and resting/exercise hemodynamics in symptomatic patients with HFrEF receiving GDMT?
In a small pilot study of HFrEF patients on GDMT, vericiguat improved flow-mediated dilation and resting hemodynamics, providing potential mechanistic insights into its clinical benefits.
Absolute Event Rate: 6.9% vs 4.7%
p-value: p=0.015
Background Vericiguat improves outcomes in heart failure with reduced ejection fraction (HFrEF), but its vascular and hemodynamic effects remain unclear. We explored changes in flow-mediated dilation (FMD) and invasive hemodynamics after vericiguat in symptomatic patients with HFrEF receiving guideline-directed medical therapy (GDMT). Methods In this single-center, open-label, single-arm exploratory pilot study, 10 patients with symptomatic HFrEF underwent assessment of FMD, right heart catheterization at rest and during 20-W supine exercise, echocardiography, laboratory testing, and 6-min walk distance (6MWD) before and after vericiguat. Vericiguat was uptitrated to 10 mg/day where tolerated. Results After treatment, FMD increased from 4.7 (3.0-6.1) to 6.9 (5.5-7.6)% ( P = .015), GLS improved from −6.8 (−8.6 to −5.5) to −9.0 (−10.5 to −6.7)% ( P = .009), resting cardiac output increased from 3.8 (3.6-5.4) to 4.6 (3.5-5.4) L/min ( P = .047), resting systemic vascular resistance decreased from 1664.1 (1327.2-1781.2) to 1293.1 (1143.6-1623.5) dyn·s·cm −5 ( P = .002), and 6MWD increased from 334.0 (251.3-395.0) to 355.0 (262.5-453.8) m ( P = .036). During 20-W exercise, cardiac output increased from 5.4 (4.6-5.9) to 6.5 (4.8-6.9) L/min ( P = .030), whereas exercise systemic vascular resistance showed only a decreasing trend ( P = .070). Conclusions In symptomatic patients with HFrEF receiving GDMT, vericiguat was associated with changes in peripheral vascular function and resting hemodynamic indices. However, exercise systemic vascular resistance did not improve significantly. These findings are exploratory and hypothesis-generating.
Funauchi et al. (Mon,) conducted a other in Heart failure with reduced ejection fraction (HFrEF) (n=10). Vericiguat was evaluated on Flow-mediated dilation (FMD) (p=0.015). Vericiguat treatment in symptomatic HFrEF patients increased flow-mediated dilation from 4.7% to 6.9% (P=0.015) and improved resting cardiac output and systemic vascular resistance.