Hida Yuki, Imamura Teruhiko, Kinugawa Koichiro
Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.
J Clin Med. 2025 Aug 19;14(16):5856. doi: 10.3390/jcm14165856.
: Vericiguat, a soluble guanylate cyclase stimulator, reduces cardiovascular events in patients with heart failure with reduced ejection fraction following clinical deterioration against guideline-directed medical therapy. However, the optimal timing for initiating vericiguat remains unclear. : We retrospectively analyzed heart failure patients with reduced/mild-reduced ejection fraction who received vericiguat between 2021 and 2025 upon optimal guideline-directed medical therapy. The primary outcome was a composite of all-cause mortality and heart failure hospitalization. Patients were stratified by the number of prior heart failure hospitalizations (<2 vs. ≥2), and outcomes were assessed using multivariable Cox regression and biomarker trajectories over 6 months. : A total of 43 patients (with a median age of 73 years, 35 were men) were included. Of these, 26 (60%) patients had ≥2 prior hospitalizations. A number of hospitalizations ≥ 2 independently predicted the primary outcome (hazard ratio: 8.43; 95% confidence interval: 1.79-39.7; = 0.007). Only patients with <2 prior hospitalizations showed significant improvements in plasma B-type natriuretic peptide levels ( = 0.049) and left ventricular ejection fraction ( = 0.016). In contrast, no meaningful biomarker changes were observed in patients with ≥2 hospitalizations. : A history of two or more heart failure hospitalizations is a strong predictor of poor outcomes during vericiguat therapy. These findings suggest that initiating vericiguat earlier-before recurrent hospitalizations-may yield greater clinical benefit.
维立西呱是一种可溶性鸟苷酸环化酶刺激剂，在射血分数降低的心力衰竭患者因临床病情恶化而未遵循指南指导的药物治疗时，可降低心血管事件的发生。然而，启动维立西呱的最佳时机仍不明确。我们回顾性分析了2021年至2025年间在接受最佳指南指导的药物治疗后接受维立西呱治疗的射血分数降低/轻度降低的心力衰竭患者。主要结局是全因死亡率和心力衰竭住院的复合结局。根据既往心力衰竭住院次数（<2次与≥2次）对患者进行分层，并使用多变量Cox回归和6个月内的生物标志物轨迹评估结局。共纳入43例患者（中位年龄73岁，35例为男性）。其中，26例（60%）患者既往住院≥2次。住院次数≥2次独立预测主要结局（风险比：8.43；95%置信区间：1.79 - 39.7；P = 0.007）。只有既往住院次数<2次的患者血浆B型利钠肽水平（P = 0.049）和左心室射血分数（P = 0.016）有显著改善。相比之下，住院次数≥2次的患者未观察到有意义的生物标志物变化。两次或更多次心力衰竭住院史是维立西呱治疗期间不良结局的有力预测指标。这些发现表明，在反复住院之前更早启动维立西呱可能会带来更大的临床益处。
