Assessment of cardiac reverse remodeling in patients with LV systolic dysfunction receiving vericiguat in addition to optimal GDMT

Background and Objective Vericiguat is a soluble guanylate cyclase stimulator which has demonstrated significant clinical and survival benefits in patient with heart failure and reduced ejection fraction (HFrEF) following acute decompensation. We present data on cardiac reverse remodeling assessed by echocardiography in ‘real-world’ patients receiving this therapy in addition to optimal guideline-directed medical therapy (GDM) for at least 6 months prior to initiation. Material and method Patients with a clinical indication for Vericiguat therapy were retrospectively analysed from a local registry between December 2022 and September 2023. A comprehensive echocardiography evaluation was performed at baseline (i.e. prior to initiation of this medication), and at 3 months after Vericiguat treatment. Results A total of 44 patients were included in this observational study, of which 32 patients were men (77.3%), and 10 patients were women (22.7%). With regards to baseline comorbidities, 17 patients had arterial hypertension, 12 patients had type-2 diabetes mellitus, 21 patients had hypercholesterolaemia, and 6 patients were newly diagnosed with HFrEF. The aetiology of HFrEF was ischaemic in 25 patients, and non-ischaemic in 19 patients. A total of 40 patients were on ARNI therapy prior to initiation of Vericiguat, 40 patients were on beta-blockers, 39 patients were on MRAs, 44 patients were on SGLT2-inhibitors, 18 patients were of loop diuretics, 15 patients had an ICD in situ, and 6 patients had a CRT device implanted. The mean initial LVEF was 31%, with a mean initial end-diastolic volume (EDV) of 178 mL. At 3-month follow-up, the mean LVEF was 39%, which represents an improvement of 9 percentage points; the mean EDV at 3-month follow-up was reduced up to 157 mL. Conclusions Vericiguat therapy may exhibit additional anti-remodelling benefits in patients with HFrEF when in combination with optimal GDMT in ‘real-world’ populations. Large randomized and prospective trials are needed to explore this hypothesis.