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Correale M, Pelaggi G, Catanoso MC, Miccichè S, Teresi L, Bonanno S, Bellocchi P, Poleggi C, Capasso R, Barile M, Visco V, Carluccio E, Nodari S, Ciccarelli M, Dattilo G. Vericiguat in heart failure with reduced ejection fraction: hope or solid reality? Heart Fail Rev 2024; 29:1135-1143. [PMID: 39044114 DOI: 10.1007/s10741-024-10425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
In recent years, thanks to the advent of new classes of drugs (ARNI and SGLT2-i), the prognosis of patients suffering from heart failure with reduced ejection fraction (HFrEF) has gradually improved. Nonetheless, there is a residual risk that is not targeted by these therapies. Currently, it is recognized that vericiguat, an oral stimulator of soluble guanylate cyclase (sGC), can restore the NO-sGC-cGMP pathway, through stimulation and activation of sGC, aiming to increase cGMP levels with a reduction in heart failure-related oxidative stress and endothelial dysfunction. Even though the Victoria trial demonstrated that HFrEF patients in treatment with vericiguat showed a 10% reduction in the composite of cardiovascular mortality and rehospitalization for heart failure, statistically significantly reducing heart failure hospitalization, the international guidelines limit its use as a second-line drug for patients with worsening symptomatology despite optimized medical therapy. Furthermore, vericiguat has proved to be a valid therapeutic ally especially in those patients with comorbidities such that they cannot receive the classic four-pillar therapy of HF (in particular renal failure). In this review, the authors report on randomized clinical trials, substudies, and meta-analysis about vericiguat in HFrEF, emphasizing the strengths that would suggest the possible role of vericiguat as the fifth pillar of the HFrEF treatment, acknowledging that there are still gaps in the evidence that need to be clarified.
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Affiliation(s)
- Michele Correale
- Cardiothoracic Department, Policlinico Riuniti University Hospital, Foggia, Italy.
| | - Giuseppe Pelaggi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Maria Concetta Catanoso
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Serena Miccichè
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Lucio Teresi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Salvatore Bonanno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Paolo Bellocchi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Cristina Poleggi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Raffaele Capasso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Barile
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Valeria Visco
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, S. Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Savina Nodari
- Department of Cardiology, University of Brescia and ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy
| | - Giuseppe Dattilo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
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Okami S, Ohlmeier C, Takeichi M, Aguila M, Holl K, Michel A, Lecomte C, Ide T. Vericiguat Use in Patients with Heart Failure in Real-World Settings during the First Year after the Drug Authorization in Japan. J Clin Med 2024; 13:3222. [PMID: 38892932 PMCID: PMC11172519 DOI: 10.3390/jcm13113222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/08/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Vericiguat was developed to treat patients with heart failure (HF). Currently, limited data are available to characterize vericiguat-treated patients in real-world clinical settings. Methods: This retrospective cohort study was done using a Japanese hospital administrative database to describe the use of vericiguat in patients with HF in real-world settings. Adult patients diagnosed with HF prescribed vericiguat between 1 July 2021 and 30 September 2022 were included. Patient characteristics at the initiation of vericiguat treatment, patterns of HF medication use, and vericiguat dose titrations were assessed within the first 90 days of treatment. Results: The study included 829 patients who were initiated on vericiguat therapy. The mean age was 75.5 years and 69.0% were male. Hypertension, coronary artery disease, and diabetes mellitus were present in 91.7, 71.3, and 60.1% of patients, respectively. Most patients had previously received HF medications, with high percentages using angiotensin-receptor blocker neprilysin inhibitors (ARNI; 43.9%) and sodium-glucose cotransporter-2 inhibitors (54.4%). During the first 90 days of vericiguat treatment, 65.8% of the patients were uptitrated from their starting dose, and 32.3% had reached the maximal daily dose. The median time to reach the maximal daily dose was 34 days. The multivariable model identified that initiating vericiguat treatment in an outpatient setting and using ARNI before initiating vericiguat treatment were factors significantly associated with reaching the maximal daily dose of vericiguat at any given time, whereas older age, chronic kidney disease, hyperkalemia, and anemia were not associated. Conclusions: These findings provide early insights into the use of vericiguat, which aid in optimizing the combinations and/or sequences of HF treatment incorporating vericiguat therapy.
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Affiliation(s)
- Suguru Okami
- Medical Affairs & Pharmacovigilance, Bayer Yakuhin Ltd., Breeze Tower, 2-4-9 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Christoph Ohlmeier
- Integrated Evidence Generation & Business Innovation, Bayer AG, 13342 Berlin, Germany
| | - Makiko Takeichi
- Medical Affairs & Pharmacovigilance, Bayer Yakuhin Ltd., Breeze Tower, 2-4-9 Umeda, Kita-ku, Osaka 530-0001, Japan
| | | | - Katsiaryna Holl
- Integrated Evidence Generation & Business Innovation, Bayer AG, 13342 Berlin, Germany
| | - Alexander Michel
- Integrated Evidence Generation & Business Innovation, Bayer Consumer Care AG, Peter Merian Straße 84, CH-4052 Basel, Switzerland
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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3
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Chen C, Lv J, Liu C. Vericiguat in patients with heart failure across the spectrum of left ventricular ejection fraction: a patient-level, pooled meta-analysis of VITALITY-HFpEF and VICTORIA. Front Endocrinol (Lausanne) 2024; 15:1335531. [PMID: 38524633 PMCID: PMC10957528 DOI: 10.3389/fendo.2024.1335531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Vericiguat, the newest soluble guanylate cyclase (sGC) drug, is potentially beneficial in treating heart failure (HF). However, most studies have only confirmed the significant impact of sGC in patients with reduced left ventricular ejection fraction (LVEF). Therefore, the main objective of this meta-analysis was to comparatively analyze the effects of Vericiguat in the entire LVEF range based on previous studies. According to PubMed, Web of Science, Cochrane, and Embase databases, randomized controlled studies in the full LVEF stage range were screened, and two extensive clinical studies on Vericiguat, namely VICTORIA (LVEF<45%) and VITALITY-HFpEF (LVEF≥45%) were identified for analysis and systematic evaluation. We separately assessed the rates of primary outcomes, cardiovascular death, and serious adverse events in both studies. The results of our research confirmed that although the criteria for the primary outcome were not the same in the two extensive studies, it was evident that there was no difference in the primary outcome between the experimental Vericiguat group and the placebo group in the VITALITY-HFpEF (LVEF≥45%) (P=0.45), whereas the primary outcome of VICTORIA (LVEF<45%) was significantly improved with the administration of Vericiguat showing a significant improvement (RR 0.93; 95% CI 0.87 to 1.00), but the effect of Vericiguat on cardiovascular mortality was not significant across the full range of LVEF (RR 0.97; 95% CI 0.86 to 1.09), and the incidence of total serious adverse events did not differ significantly between the two studies (RR 0.96; 95% CI 0.89 to 1.03). Surprisingly, partial subgroups analysis of serious adverse events found that vericiguat treatment reduced the incidence of all-cause death, Cardiac disorders, Hypotension, and Hypertension in patients with LVEF<45%, with a particular effect on the incidence of Cardiac disorders. Taken together, Vericiguat had a significant benefit in HF patients with LVEF<45%, especially in patients with LVEF<24%; it had a less pronounced effect in HF patients with LVEF ≥45%, but no adverse effects were observed.
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Affiliation(s)
| | | | - Changzhao Liu
- Cardiovascular Disease Center, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, Hubei, China
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Yang H, Luo C, Lan WQ, Tang YH. Vericiguat treatment of heart failure: A systematic review and meta-analysis. World J Clin Cases 2023; 11:8330-8342. [PMID: 38130613 PMCID: PMC10731201 DOI: 10.12998/wjcc.v11.i35.8330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Heart failure (HF), an end-stage manifestation of various cardiac diseases, poses an enormous economic and health burden on society. Vericiguat may be an effective drug in the treatment of HF. AIM To explore by meta-analysis the efficacy and safety of Vericiguat in treating chronic heart failure. METHODS Databases, including PubMed, EMBASE, Web of Science, and Cochrane Library, were searched to collect all published randomized controlled trials (RCTs) on Vericiguat treatment of chronic heart failure from the earliest electronic records to those published in March 2023. Two investigators independently screened the literature according to inclusion and exclusion criteria, evaluated the quality of the studies, and extracted valid data before conducting a meta-analysis using RevMan5.4. RESULTS Four RCTs with 5919 patients were included, and the meta-analysis showed that treatment with 10 mg Vericiguat reduced the incidence of the primary endpoint (a composite of cardiovascular mortality and first heart-failure-related hospitalization) in patients with chronic heart failure compared to placebo [relative risk (RR) = 0.91, 95% confidence interval (CI): 0.85-0.98, P = 0.01], and reduced the incidence of heart-failure-related hospitalization (RR = 0.92, 95%CI: 0.84-1.00, P = 0.05). However, for the incidence of cardiovascular and all-cause death, there were no significant differences between the Vericiguat and placebo groups. In addition, the two groups did not show significant differences in blood pressure, heart rate, and Kansas Cardiomyopathy Questionnaire physical limitation score. In terms of safety, 10 mg Vericiguat did not increase the risk of adverse effects in patients with chronic heart failure. Vericiguat may increase the risk of symptomatic hypotension (RR = 1.17, 95%CI: 0.98-1.39, P = 0.08) and syncope (RR = 1.18, 95%CI: 0.90-1.55, P = 0.24), but not significantly. CONCLUSION Vericiguat (10 mg) was more effective than placebo in treating patients with chronic heart failure and had a better safety profile.
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Affiliation(s)
- Heng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi Province, China
| | - Chao Luo
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi Province, China
| | - Wan-Qi Lan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi Province, China
| | - Yan-Hua Tang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330008, Jiangxi Province, China
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Villaschi A, Pagnesi M, Stolfo D, Baldetti L, Lombardi CM, Adamo M, Loiacono F, Sammartino AM, Colombo G, Tomasoni D, Inciardi RM, Maccallini M, Gasparini G, Montella M, Contessi S, Cocianni D, Perotto M, Barone G, Merlo M, Cappelletti AM, Sinagra G, Pini D, Metra M, Chiarito M. Ischemic Etiology in Advanced Heart Failure: Insight from the HELP-HF Registry. Am J Cardiol 2023; 204:268-275. [PMID: 37562192 DOI: 10.1016/j.amjcard.2023.07.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
In patients with advanced heart failure (HF), defined according to the presence of at least one I-NEED-HELP criterium, the updated 2018 Heart Failure Association of the European Society of Cardiology (HFA-ESC) criteria for advanced HF identify a subgroup of patients with HF with worse prognosis, but whether ischemic etiology has a relevant prognostic impact in this very high-risk cohort is unknown. Patients from the HELP-HF registry were stratified according to ischemic etiology and presence of advanced HF based on 2018 HFA-ESC criteria. The primary end point was a composite of all-cause death and HF hospitalization at 1 year. Secondary end points were all-cause death, HF hospitalization, and cardiovascular death at 1 year. Ischemic etiology was a leading cause of HF, in both patients with advanced and nonadvanced HF (46.1% and 42.4%, respectively, p = 0.337). The risk of the primary end point (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.09 to 1.58) and all-cause mortality (HR 1.37, 95% CI 1.06 to 1.76) was increased in ischemic as compared with nonischemic patients. The risk of the primary end point was consistently higher in ischemic patients in both patients with advanced and nonadvanced HF (advanced HF, HR 1.50 95% CI 1.04 to 2.16; nonadvanced HF, HR 1.25 95% CI 1.01 to 1.56, pinteraction = 0.333), driven by an increased risk of mortality, mainly because of cardiovascular causes. In conclusion, ischemic etiology is the most common cause of HF in patients with at least one I-NEED-HELP marker and with or without advanced HF as defined by the 2018 HFA-ESC definition. In both patients with advanced and not-advanced HF, ischemic etiology carried an increased risk of worse prognosis.
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Affiliation(s)
- Alessandro Villaschi
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Mario Lombardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Antonio Maria Sammartino
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giada Colombo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Maria Inciardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marta Maccallini
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Gaia Gasparini
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Marco Montella
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Stefano Contessi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Daniele Cocianni
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Maria Perotto
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Giuseppe Barone
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Daniela Pini
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy.
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Mauro Chiarito
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
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Yogasundaram H, Zheng Y, Ly E, Ezekowitz J, Ponikowski P, Lam CSP, O'Connor C, Blaustein RO, Roessig L, Temple T, Westerhout CM, Armstrong PW, Sandhu RK. Relationship between baseline electrocardiographic measurements and outcomes in patients with high-risk heart failure: Insights from the VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial. Eur J Heart Fail 2023; 25:1822-1830. [PMID: 37655679 DOI: 10.1002/ejhf.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/03/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
AIMS Whether electrocardiographic (ECG) measurements predict mortality in chronic heart failure with reduced ejection fraction (HFrEF) is unknown. METHODS AND RESULTS We studied 4880 patients from the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial with a baseline 12-lead ECG. Associations between ECG measurements and mortality were estimated as hazard ratios (HR) and adjusted for the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score, N-terminal pro-B-type natriuretic peptide, and index event. Select interactions between ECG measurements, patient characteristics and mortality were examined. Over a median of 10.8 months, there were 824 cardiovascular (CV) deaths (214 sudden) and 1005 all-cause deaths. Median age was 68 years (interquartile range [IQR] 60-76), 24% were women, median ejection fraction was 30% (IQR 23-35), 41% had New York Heart Association class III/IV, and median MAGGIC score was 24 (IQR 19-28). After multivariable adjustment, significant associations existed between heart rate (per 5 bpm: HR 1.02), QRS duration (per 10 ms: HR 1.02), absence of left ventricular hypertrophy (HR 0.64) and CV death, and similarly so with all-cause death (HR 1.02; HR 1.02; HR 0.61, respectively). Contiguous pathologic Q waves were significantly associated with sudden death (HR 1.46), and right ventricular hypertrophy with all-cause death (HR 1.44). The only sex-based interaction observed was for pathologic Q waves on CV (men: HR 1.05; women: HR 1.64, pinteraction = 0.024) and all-cause death (men: HR 0.99; women: HR 1.57; pinteraction = 0.010). Whereas sudden death doubled in females, it did not differ among males (male: HR 1.25, 95% confidence interval [CI] 0.87-1.79; female: HR 2.50, 95% CI 1.23-5.06; pinteraction = 0.141). CONCLUSION Routine ECG measurements provide additional prognostication of mortality in high-risk HFrEF patients, particularly in women with contiguous pathologic Q waves.
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Affiliation(s)
| | - Yinggan Zheng
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Eric Ly
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Justin Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore & Duke-National University of Singapore, Singapore, Singapore
| | | | | | | | - Tracy Temple
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | | | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
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Falco L, Brescia B, Catapano D, Martucci ML, Valente F, Gravino R, Contaldi C, Pacileo G, Masarone D. Vericiguat: The Fifth Harmony of Heart Failure with Reduced Ejection Fraction. J Cardiovasc Dev Dis 2023; 10:388. [PMID: 37754817 PMCID: PMC10531735 DOI: 10.3390/jcdd10090388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure with reduced ejection fraction have a high residual risk of adverse outcomes, even when treated with optimal guideline-directed medical therapy and in a clinically stable state. Worsening heart failure episodes represent a critical event in the heart failure trajectory, carrying high residual risk at discharge and dismal short- or long-term prognosis. Recently, vericiguat, a soluble guanylate cyclase stimulator, has been proposed as a novel drug whose use is already associated with a reduction in heart failure-related hospitalizations in patients in guideline-directed medical therapy. In this review, we summarized the pathophysiology of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate cascade in patients with heart failure with reduced ejection fraction, the pharmacology of vericiguat as well as the evidence regarding their use in patients with HFrEF. Finally, tips and tricks for its use in standard clinical practice are provided.
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Affiliation(s)
- Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Benedetta Brescia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Maria Luigia Martucci
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
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8
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Di Fusco SA, Alonzo A, Aimo A, Matteucci A, Intravaia RCM, Aquilani S, Cipriani M, De Luca L, Navazio A, Valente S, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. ANMCO position paper on vericiguat use in heart failure: from evidence to place in therapy. Eur Heart J Suppl 2023; 25:D278-D286. [PMID: 37213802 PMCID: PMC10194817 DOI: 10.1093/eurheartjsupp/suad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In the growing therapeutic armamentarium for heart failure (HF) management, vericiguat represents an innovative therapeutic option. The biological target of this drug is different from that of other drugs for HF. Indeed, vericiguat does not inhibit neuro-hormonal systems overactivated in HF or sodium-glucose co-transporter 2 but stimulates the biological pathway of nitric oxide and cyclic guanosine monophosphate, which is impaired in patients with HF. Vericiguat has recently been approved by international and national regulatory authorities for the treatment of patients with HF and reduced ejection fraction who are symptomatic despite optimal medical therapy and have worsening HF. This ANMCO position paper summarises key aspects of vericiguat mechanism of action and provides a review of available clinical evidence. Furthermore, this document reports use indications based on international guideline recommendations and local regulatory authority approval at the time of writing.
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Affiliation(s)
- Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Alessandro Alonzo
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Alberto Aimo
- Interdisciplinary Center for Health Science, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà 33, Pisa, 56127, Italy
| | - Andrea Matteucci
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Rita Cristina Myriam Intravaia
- Cardiologia 4-Diagnostica e Riabilitativa, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, Milan, 20162, Italy
| | - Stefano Aquilani
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
| | - Manlio Cipriani
- U.O. Cardiologia, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-ISMETT, Via Ernesto Tricomi 5, Palermo, 90127, Italy
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, Rome, 00152, Italy
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia—IRCCS, Viale Risorgimento 80, Reggio Emilia, 42123, Italy
| | - Serafina Valente
- Dipartimento Cardio-Toracico, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Viale Mario Bracci 16, Siena, 53100, Italy
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Via Palermo 636, Catania, 95122, Italy
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, Rome, 00152, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Via Alfonso la Marmora 36, Firenze, 50121, Italy
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, Milan, 20162, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—, ASL Roma 1, 00135, Italy
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9
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Leancă SA, Afrăsânie I, Crișu D, Matei IT, Duca ȘT, Costache AD, Onofrei V, Tudorancea I, Mitu O, Bădescu MC, Șerban LI, Costache II. Cardiac Reverse Remodeling in Ischemic Heart Disease with Novel Therapies for Heart Failure with Reduced Ejection Fraction. Life (Basel) 2023; 13:1000. [PMID: 37109529 PMCID: PMC10143569 DOI: 10.3390/life13041000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Despite the improvements in the treatment of coronary artery disease (CAD) and acute myocardial infarction (MI) over the past 20 years, ischemic heart disease (IHD) continues to be the most common cause of heart failure (HF). In clinical trials, over 70% of patients diagnosed with HF had IHD as the underlying cause. Furthermore, IHD predicts a worse outcome for patients with HF, leading to a substantial increase in late morbidity, mortality, and healthcare costs. In recent years, new pharmacological therapies have emerged for the treatment of HF, such as sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, selective cardiac myosin activators, and oral soluble guanylate cyclase stimulators, demonstrating clear or potential benefits in patients with HF with reduced ejection fraction. Interventional strategies such as cardiac resynchronization therapy, cardiac contractility modulation, or baroreflex activation therapy might provide additional therapeutic benefits by improving symptoms and promoting reverse remodeling. Furthermore, cardiac regenerative therapies such as stem cell transplantation could become a new therapeutic resource in the management of HF. By analyzing the existing data from the literature, this review aims to evaluate the impact of new HF therapies in patients with IHD in order to gain further insight into the best form of therapeutic management for this large proportion of HF patients.
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Affiliation(s)
- Sabina Andreea Leancă
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Irina Afrăsânie
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Daniela Crișu
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Iulian Theodor Matei
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ștefania Teodora Duca
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iași, Romania
| | - Viviana Onofrei
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ionuţ Tudorancea
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ovidiu Mitu
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Minerva Codruța Bădescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Lăcrămioara Ionela Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Irina Iuliana Costache
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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10
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Escobar Cervantes C, Esteban Fernández A, Recio Mayoral A, Mirabet S, González Costello J, Rubio Gracia J, Núñez Villota J, González Franco Á, Bonilla Palomas JL. Identifying the patient with heart failure to be treated with vericiguat. Curr Med Res Opin 2023; 39:661-669. [PMID: 36897009 DOI: 10.1080/03007995.2023.2189857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
The pathophysiology of heart failure with reduced ejection fraction (HFrEF) is a complex process in which a number of neurohormonal systems are involved. Targeting only some of these systems, but not all, translates into a partial benefit of HF treatment. The nitric oxide-soluble guanylate cyclase (sGC)-cGMP pathway is impaired in HF, leading to cardiac, vascular and renal disturbances. Vericiguat is a once-daily oral stimulator of sGC that restores this system. No other disease-modifying HF drugs act on this system. Despite guidelines recommendations, a substantial proportion of patients are not taking all recommended drugs or when taking them, they do so at low doses, limiting their potential benefits. In this context, treatment should be optimized considering different parameters, such as blood pressure, heart rate, renal function, or potassium, as they may interfere with their implementation at the recommended doses. The VICTORIA trial showed that adding vericiguat to standard therapy in patients with HFrEF significantly reduced the risk of cardiovascular death or HF hospitalization by 10% (NNT 24). Furthermore, vericiguat does not interfere with heart rate, renal function or potassium, making it particularly useful for improving the prognosis of patients with HFrEF in specific settings and clinical profiles.
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Affiliation(s)
| | | | | | - Sonia Mirabet
- Cardiology Department, Hospital de Sant Pau, Barcelona, Spain
| | - José González Costello
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- BIOHEART-Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Spain
- Ciber Cardiovascular (CIBERCV), Instituto Salud Carlos III, Madrid, Spain
| | - Jorge Rubio Gracia
- Internal Medicine Department, Hospital Clínico Univeristario Lozano Blesa, University of Zaragoza, Spain
| | - Julio Núñez Villota
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Universidad de Valencia, INCLIVA, CIBER Cardiovascular, Valencia, Spain
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11
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Chen L, Zhou X, Deng Y, Yang Y, Chen X, Chen Q, Liu Y, Fu X, Kwan HY, You Y, Jin W, Zhao X. Zhenwu decoction ameliorates cardiac hypertrophy through activating sGC (soluble guanylate cyclase) - cGMP (cyclic guanosine monophosphate) - PKG (protein kinase G) pathway. JOURNAL OF ETHNOPHARMACOLOGY 2023; 300:115705. [PMID: 36099983 DOI: 10.1016/j.jep.2022.115705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Zhenwu Decoction (ZWD) is a traditional Chinese medicine (TCM) formula which has wide scope of indications related to Yang deficiency and dampness retention in TCM syndrome. Cardiac hypertrophy can induce similar symptoms and signs to the clinical features of Yang deficiency and dampness retention syndrome. ZWD can increase the left ventricular ejection fraction, reduce cardiac hypertrophy of patients with chronic heart failure. However, its underlying pharmacological mechanism remains unclear. AIM OF THE STUDY The study aimed to confirm the protective effects of ZWD on cardiac hypertrophy and explore the underlying mechanisms. MATERIALS AND METHODS The potential targets and pathways of ZWD in cardiac hypertrophy were highlighted by network pharmacology and validated by mechanistic and functional studies. RESULTS Our network pharmacology analysis suggests that the protective effects of ZWD on cardiac hypertrophy are related to cyclic guanosine monophosphate (cGMP) - protein kinase G (PKG) pathway. Subsequent animal studies showed that ZWD significantly ameliorated cardiac function decline, cardiac hypertrophy, cardiac fibrosis and cardiomyocyte apoptosis. To explore the underlying mechanisms of action, we performed Western blotting, immunohistochemical analysis, and detection of inflammatory response and oxidative stress. Our results showed that ZWD activated the soluble guanylate cyclase (sGC) - cGMP - PKG signaling pathway. The sGC inhibitor ODQ that blocks the sGC-cGMP-PKG signaling pathway in zebrafish abolished the protective effects of ZWD, suggesting sGC-cGMP-PKG is the main signaling pathway mediates the protective effect of ZWD in cardiac hypertrophy. In addition, three major ingredients from ZWD, poricoic acid C, hederagenin and dehydrotumulosic acid, showed a high binding energy with prototype sGC. CONCLUSION ZWD reduces oxidative stress and inflammation and exerts cardioprotective effects by activating the sGC-cGMP-PKG signaling pathway.
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Affiliation(s)
- Liqian Chen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Xinghong Zhou
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Yijian Deng
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Ying Yang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Xiaohu Chen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Qinghong Chen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Yanyan Liu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Xiuqiong Fu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
| | - Hiu Yee Kwan
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
| | - Yanting You
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Wen Jin
- Department of Cardiac Intensive Care Unit, Cardiovascular Hospital, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, 510317, China.
| | - Xiaoshan Zhao
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
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12
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Kaplinsky E, Perrone S, Barbagelata A. Emerging concepts in heart failure management and treatment: focus on vericiguat. Drugs Context 2023; 12:dic-2022-5-5. [PMID: 36660012 PMCID: PMC9828868 DOI: 10.7573/dic.2022-5-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/26/2022] [Indexed: 01/04/2023] Open
Abstract
The nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway is dysregulated in patients with heart failure (HF) resulting in myocardial and vascular dysfunction that contributes to its progression. Vericiguat is a novel direct sGC stimulator that targets in at least two ways the NO-sGC-cGMP pathway with the subsequent restoration of cGMP activity. The VICTORIA trial assessed the effects of vericiguat (versus placebo) in 5050 patients with chronic HF (NYHA class II-IV), left ventricular ejection fraction (LVEF) <45%, elevated natriuretic peptide levels and a recent HF decompensation (hospitalized or outpatient intravenous diuretics). After a median follow-up of 10.8 months, a lower risk (10% reduction) of the primary combined outcome (cardiovascular death or HF hospitalization) was achieved (HR 0.90, 95% CI 0.83-0.98; p=0.02). The composite endpoint was driven by HF hospitalizations (HR 0.9, 95% CI 0.81-1.00; p=0.048) whilst CV death reduction was not statistically significant on its own. The target dose was achieved in 89% of patients treated with vericiguat, and no significant differences were observed in the rates of syncope or hypotension. The VICTORIA trial showed that vericiguat was safe, well tolerated and without need of laboratory testing. The aim of this review is to provide comprehensive information about vericiguat in terms of its differential mechanism of action and clinical data particularly focused on the VICTORIA trial. A comparison is also made with DAPA-HF and EMPEROR-Reduced considering that, in all these contemporary trials, a new study medication was added to the standard triple HF therapy. This is a relevant issue because the VICTORIA trial had a significant but less powerful effect than DAPA-HF and EMPEROR-Reduced on HF outcomes in a setting of more severe disease, higher event rate and shorter follow-up. In addition, relevant data on other previous studies are also provided in both HF with reduced LVEF (SOCRATES-Reduced) and HF with preserved LVEF (SOCRATES-Preserved and VITALITY-Preserved). This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.
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Affiliation(s)
- Edgardo Kaplinsky
- Cardiology Unit, Medicine Department, Hospital Municipal de Badalona, Spain
| | - Sergio Perrone
- Catholic University Argentina/Fleni Institute, Buenos Aires, Argentina
| | - Alejandro Barbagelata
- Catholic University Argentina/Fleni Institute, Buenos Aires, Argentina,Duke University School of Medicine, Durham, NC, USA
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13
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Tomasoni D, Adamo M, Metra M. May 2022 at a glance. Focus on treatment: from epidemiologic data to randomized trials and new devices. Eur J Heart Fail 2022; 24:735-737. [PMID: 35592905 DOI: 10.1002/ejhf.2230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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14
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Emdin M, Aimo A, Castiglione V. Is Targeting Cyclic Guanosine Monophosphate by Vericiguat Effective to Treat Ischaemic Heart Failure with Reduced Ejection Fraction? Yes, It Is. Eur J Heart Fail 2022; 24:791-793. [PMID: 35445790 DOI: 10.1002/ejhf.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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