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Effect of vericiguat on left ventricular structure and function in patients with heart failure with reduced ejection fraction: The VICTORIA echocardiographic substudy |
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| Authors: | Burkert Pieske Elisabeth Pieske-Kraigher Carolyn S.P. Lam Vojtěch Melenovský Karen Sliwa Yuri Lopatin Juan Luis Arango M. Cecilia Bahit Christopher M. O'Connor Mahesh J. Patel Lothar Roessig Daniel A. Morris Martin Kropf Cynthia M. Westerhout Yinggan Zheng Paul W. Armstrong for the VICTORIA Study Group |
| Affiliation: | 1. Charité University Medicine, German Heart Center, Berlin, Germany;2. National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore;3. Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic;4. Cape Heart Institute, University of Cape Town, Cape Town, South Africa;5. Volgograd State Medical University, Volgograd Regional Cardiology Center, Volgograd, Russian Federation;6. Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala;7. INECO Neurociencias Oroño, Fundación INECO, Rosario, Argentina;8. Inova Heart and Vascular Institute, Falls Church, VA, USA;9. Merck & Co., Inc., Rahway, NJ, USA;10. Bayer AG, Wuppertal, Germany;11. Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada |
| Abstract: | AimVericiguat significantly reduced the primary composite outcome of heart failure (HF) hospitalization or cardiovascular death in the VICTORIA trial. It is unknown if these outcome benefits are related to reverse left ventricular (LV) remodelling with vericiguat in patients with HF with reduced ejection fraction (HFrEF). The aim of this study was to compare the effects of vericiguat versus placebo on LV structure and function after 8 months of therapy in patients with HFrEF.Methods and resultsStandardized transthoracic echocardiography (TTE) was performed at baseline and after 8 months of therapy in a subset of HFrEF patients in VICTORIA. The co-primary endpoints were changes in LV end-systolic volume index (LVESVI) and LV ejection fraction (LVEF). Quality assurance and central reading were performed by an echocardiographic core laboratory blinded to treatment assignment. A total of 419 patients (208 vericiguat, 211 placebo) with high-quality paired TTE at baseline and 8 months were included. Baseline clinical characteristics were well balanced between treatment groups and echocardiographic characteristics were representative of patients with HFrEF. LVESVI significantly declined (60.7 ± 26.8 to 56.8 ± 30.4 ml/m2; p < 0.01) and LVEF significantly increased (33.0 ± 9.4% to 36.1 ± 10.2%; p < 0.01) in the vericiguat group, but similarly in the placebo group (absolute changes for vericiguat vs. placebo: LVESVI −3.8 ± 15.4 vs. −7.1 ± 20.5 ml/m2; p = 0.07 and LVEF +3.2 ± 8.0% vs. +2.4 ± 7.6%; p = 0.31). The absolute rate per 100 patient-years of the primary composite endpoint at 8 months tended to be lower in the vericiguat group (19.8) than the placebo group (29.6) (p = 0.07).ConclusionsIn this pre-specified echocardiographic study, significant improvements in LV structure and function occurred over 8 months in both vericiguat and placebo in a high-risk HFrEF population with recent worsening HF. Further studies are warranted to define the mechanisms of vericiguat's benefit in HFrEF. |
| Keywords: | Heart failure with reduced ejection fraction Echocardiography Left ventricular structure Left ventricular function Vericiguat |