Vericiguat and exercise capacity in patients with HFrEF; a prospective randomized study

Vericiguat (V) reduces the risk of cardiovascular death in patients with HFrEF and no recent worsening. Conversely, no randomized controlled data exist on exercise capacity effect of V in these patients.

To assess the effect of V in exercise capacity of patients with HFrEF.

In this prospective controlled study, patients with HFrEF and NYHA II-IV were randomly assigned to V or optimal medical treatment (C). Changes in cardiac biomarkers (NTproBNP and soluble ST2) and exercise capacity assessed by cardiopulmonary exercise test (CPET) before randomization and 12 months after, were the end points of our study. In the V group, vericiguat was initiated at a dose of 2.5 mg o.i.d and up-titrated during a period of 3 weeks to reach the maximally tolerated dose (the target dose was 10 mg o.i.d).

Fourty patients with HFrEF (mean age: 68y, NYHA: 2.7±0.6, Ejection fraction: 28±9%) were randomized in the study. Both groups were well balanced and no difference in baseline characteristics was observed. Furthermore, no significant difference in cardiac biomarkers and exercise capacity (peak VO2max, % predicted VO2, VE/VCO2 slope) was observed both at baseline and follow-up in V and C groups (Figure).

Vericiguat does not improve exercise capacity as compared to optimal medical treatment in patients with HFrEF.For image description, please refer to the figure legend and surrounding text.