Evaluating haemodynamic changes: vericiguat in patients with heart failure with reduced ejection fraction

Abstract

Aims: Vericiguat has been used to treat patients with heart failure with reduced ejection fraction (HFrEF) who demonstrated worsening heart failure despite treatment with other guideline-directed medical therapies. The haemodynamic effects of vericiguat remain unclear.

Methods and results: This study enrolled 12 patients (median age, 63 [quartiles 53.5, 70] years; 16.7%(N=2) women) with symptomatic HFrEF (New York Heart Association functional class II-IV) who demonstrated worsening heart failure despite treatment with the four foundational guideline-recommended therapies between March and December 2022, with follow-ups completed in June 2023. A balloon-tipped pulmonary artery thermodilution catheter was placed in the right internal jugular vein to perform right heart catheterisation (RHC) on day 1. Haemodynamic data were acquired before and after vericiguat intake (2.5 mg) on days 2 and 3. The data on days 2 and 3 were averaged. RHC was repeated on day 105 (37, 168). Oral intake of vericiguat 2.5 mg decreased mean pulmonary artery pressure (19.3 [14.3, 26.8] mmHg) and pulmonary artery wedge pressure (PAWP) (11 [7.5, 15] mmHg) before the intake to mean pulmonary artery pressure (17.5 [12.5, 24] mmHg) and PAWP (9.3 [6.8, 14] mmHg) at 30 min after (both P < 0.05). Reduction in PAWP was also found from 14.5 [9.5, 19.5] mmHg on day 1 to 9.5 [6.5, 12.5] mmHg on day 105 (37, 168) (P < 0.05), when vericiguat was titrated to 2.5 mg 25% (N = 3), 5 mg 50% (N = 6), and 10 mg 25% (N = 3).

Conclusions: The consistent reduction in PAWP underscores the well-tolerated nature of vericiguat and its potential to enhance cardiac performance in patients with HFrEF.

Keywords: Haemodynamics; Heart failure; Pulmonary artery wedge pressure; Right heart catheterization; Vericiguat.

Figure 1

Box plots illustrate changes in MABP, MPAP, PAWP, CI, SVR and PVR at 15 min before (0 h) and 30 min (0.5 h), 1, 2, 3 and 5 h after the intake of 2.5 mg vericiguat (A–F). Comparisons of the six right‐heart catheterisation data on day 1 (baseline) with those on a median of 105 days (follow‐up) (G–L). Circles, triangles and rectangles indicate data with vericiguat 2.5 mg (N = 3), 5 mg (N = 6), and 10 mg (N = 3), respectively. ^** P < 0.01 (crude P < 0.0003) after Dunnett's corrections. *P < 0.05 (crude P < 0.0083). CI, cardiac index; MABP, mean arterial blood pressure; MPAP, mean pulmonary artery pressure; PAWP, pulmonary artery wedge pressure; PVR, pulmonary vascular resistance; SVR, systemic vascular resistance.