LAUSR

BACKGROUND Vericiguat significantly reduced the primary composite outcome of heart failure (HF) hospitalization or cardiovascular death in the VICTORIA trial. It is unknown if these outcome benefits are related to reverse left ventricular (LV) remodeling with vericiguat in patients with HF with reduced ejection fraction (HFrEF). AIM To compare the effects of vericiguat versus placebo on LV structure and function after 8 months of therapy in patients with HFrEF. METHODS Standardized transthoracic echocardiography (TTE) was performed at baseline and after 8 months of therapy in a subset of HFrEF patients in VICTORIA. The co-primary endpoints were changes in LV end-systolic volume index (LVESVI) and LV ejection fraction (LVEF). Quality assurance and central reading was performed by an echocardiographic core laboratory blinded to treatment assignment. RESULTS A total of 419 patients (208 vericiguat, 211 placebo) with high-quality paired TTE at baseline and 8 months were included. Baseline clinical characteristics were well balanced between treatment groups and echocardiographic characteristics were representative of patients with HFrEF. LVESVI significantly declined (60.7±26.8 to 56.8±30.4 mL/m2 ; p<0.01) and LVEF significantly increased (33.0±9.4% to 36.1±10.2%; p<0.01) in the vericiguat group, but similarly in the placebo group (absolute changes for vericiguat vs. placebo: LVESVI -3.8±15.4 vs. -7.1±20.5 mL/m2 ; p=0.07 and LVEF +3.2±8.0% vs. +2.4±7.6%; p=0.31). The absolute rate per 100 pt-years of the primary composite endpoint at 8 months tended to be lower in the vericiguat group (19.8%) than the placebo group (29.6%) (p=0.07). CONCLUSIONS In this pre-specified echocardiographic study, significant improvements in LV structure and function occurred over 8 months in both vericiguat and placebo in a high-risk HFrEF population with recent worsening HF. Further studies are warranted to define the mechanisms of vericiguat's benefit in HFrEF.