Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Division of Brain Sciences, Imperial College London, London, UK.
ESC Heart Fail. 2024 Aug;11(4):2451-2454. doi: 10.1002/ehf2.14802. Epub 2024 Apr 29.
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.
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).
The consistent reduction in PAWP underscores the well-tolerated nature of vericiguat and its potential to enhance cardiac performance in patients with HFrEF.
维立西呱已被用于治疗射血分数降低的心力衰竭（HFrEF）患者，这些患者在接受其他指南推荐的医学治疗后心力衰竭恶化。维立西呱的血液动力学效应仍不清楚。
这项研究纳入了 12 名（中位年龄 63 [四分位距 53.5，70] 岁；16.7%[N=2]为女性）有症状的 HFrEF（纽约心脏协会功能分级 II-IV 级）患者，他们在 2022 年 3 月至 12 月期间接受了四项基础指南推荐的治疗方案，但心力衰竭仍恶化，在 2023 年 6 月完成了随访。在右颈内静脉内置入球囊尖端肺动脉热稀释导管进行右心导管检查（RHC）。在第 2 天和第 3 天摄入维立西呱（2.5mg）前和后获取血液动力学数据。第 2 天和第 3 天的数据取平均值。在第 105 天（37，168）重复 RHC。口服维立西呱 2.5mg 可降低平均肺动脉压（19.3 [14.3，26.8]mmHg）和肺动脉楔压（11 [7.5，15]mmHg），在摄入后 30 分钟降至平均肺动脉压（17.5 [12.5，24]mmHg）和肺动脉楔压（9.3 [6.8，14]mmHg）（均 P < 0.05）。在第 1 天从 14.5 [9.5，19.5]mmHg 降至第 105 天的 9.5 [6.5，12.5]mmHg（37，168）时，也发现肺动脉楔压下降（均 P < 0.05），当时维立西呱滴定至 2.5mg 25%（N = 3）、5mg 50%（N = 6）和 10mg 25%（N = 3）。
肺动脉楔压的持续降低突出了维立西呱良好的耐受性及其在 HFrEF 患者中增强心功能的潜力。
