Esteban-Fernández Alberto, Recio-Mayoral Alejandro, López-Vilella Raquel, de Lara Gregorio, Barrantes-Castillo Moisés, Gómez-Otero Inés, Nuñez-Villota Julio, Robles-Gamboa Carolina, López-Aguilera José, Iniesta-Manjavacas Ángel, Fluviá Paula, Pastor-Pérez Francisco, Belarte-Tornero Laia, Alonso-Salinas Gonzalo, Díez-Villanueva Pablo
Cardiology Service, Hospital Universitario Severo Ochoa, Madrid, Spain.
Faculty of Health Sciences, Alfonso X El Sabio University, Madrid, Spain.
Front Cardiovasc Med. 2025 Jan 6;11:1504427. doi: 10.3389/fcvm.2024.1504427. eCollection 2024.
Vericiguat, an oral stimulator of soluble guanylate cyclase, reduces cardiovascular mortality and hospitalisations in patients with heart failure (HF) and reduced ejection fraction, as demonstrated in the VICTORIA trial. This study assessed the real-world use of vericiguat.
This cross-sectional, prospective and multicenter registry (VERISEC) included 776 patients from 43 centres in Spain between December 2022 and October 2023. Of these patients, 79.6% were male, with a mean age of 72.4 (SD:8.7) years. Patients in VERISEC were older and had more comorbidities (diabetes, advanced chronic kidney disease) compared to VICTORIA, with 20% having an estimated glomerular filtration rate below 30 ml/min. They also had higher natriuretic peptide levels [NT-proBNP: 3551 (IQR: 1,675.9, 7,054.0)] pg/ml. Most patients (79.8%) started vericiguat after HF decompensation within the previous three months, with high use of loop diuretics (with an average dose of 65 mg/day) and implanted devices (50%). Sixty percent of patients were on quadruple therapy, with a higher use of sodium-glucose co-transporter 2 inhibitors compared to the VICTORIA trial. Despite the more severe disease in the VERISEC cohort, the implementation of guideline-directed medical therapy was greater than in VICTORIA, although vericiguat was initiated at lower blood pressure levels.
Patients in the VERISEC registry had more severe illness and higher comorbidities compared to those in the VICTORIA, despite receiving optimised treatments. Further research is needed to identify which patients may benefit the most from vericiguat treatment.
可溶性鸟苷酸环化酶口服刺激剂维立西呱可降低射血分数降低的心力衰竭（HF）患者的心血管死亡率和住院率，这在VICTORIA试验中得到了证实。本研究评估了维立西呱的实际应用情况。
这项横断面、前瞻性多中心注册研究（VERISEC）纳入了2022年12月至2023年10月期间来自西班牙43个中心的776例患者。在这些患者中，79.6%为男性，平均年龄为72.4（标准差：8.7）岁。与VICTORIA试验中的患者相比，VERISEC研究中的患者年龄更大，合并症更多（糖尿病、晚期慢性肾脏病），20%的患者估计肾小球滤过率低于30ml/分钟。他们的利钠肽水平也更高[NT-proBNP：3551（四分位间距：1675.9，7054.0）]pg/ml。大多数患者（79.8%）在过去三个月内心力衰竭失代偿后开始使用维立西呱，袢利尿剂的使用率很高（平均剂量为65mg/天），植入装置的使用率为50%。60%的患者接受四联疗法，与VICTORIA试验相比，钠-葡萄糖协同转运蛋白2抑制剂的使用率更高。尽管VERISEC队列中的疾病更为严重，但尽管维立西呱是在较低血压水平开始使用的，但指南指导的药物治疗的实施情况仍高于VICTORIA试验。
与VICTORIA试验中的患者相比，VERISEC注册研究中的患者疾病更为严重，合并症更多，尽管接受了优化治疗。需要进一步研究以确定哪些患者可能从维立西呱治疗中获益最大。
