Effect of Vericiguat on Left Ventricular Structure and Function in Patients with Heart Failure with Reduced Ejection Fraction: The VICTORIA Echocardiographic Substudy

Pieske, B; Pieske-Kraigher, E; Lam, CSP; Melenovský, V; Sliwa, K; Lopatin, Y; Arango, JL; Bahit, MC; O'Connor, CM; Patel, MJ; Roessig, L; Morris, DA; Kropf, M; Westerhout, CM; Zheng, Y; Armstrong, PW; VICTORIA Study Group

doi:10.1002/ejhf.2836

Heart failure & cardiomyopathies

Effect of Vericiguat on Left Ventricular Structure and Function in Patients with Heart Failure with Reduced Ejection Fraction: The VICTORIA Echocardiographic Substudy

Eur J Heart FailPublished 18 Apr 2023Secondary analysis of the VICTORIA randomised trial

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Authors' conclusion

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.

Study context

Population: Patients with HF with reduced ejection fraction (HFrEF) in VICTORIA with high-quality paired TTE at baseline and 8 months
Participants: 419 patients

Comparison: Vericiguat vs placebo
Vericiguatn = 208
Placebon = 211reference
Primary endpoint: Co-primary: changes in left ventricular (LV) end-systolic volume index (LVESVI) and LVEF
Follow-up: 8 months

Methodological detailspre-specified echocardiographic substudy, core laboratory blinded to treatment assignment

Pre-specified echocardiographic substudy
Core laboratory blinded to treatment assignment

Primary result

As reported in the abstract

Group	LV end-systolic volume index (LVESVI) absolute change	LV ejection fraction (LVEF) absolute change
Vericiguat	−3.8 ± 15.4 ml/m²	+3.2 ± 8.0%
Placebo	−7.1 ± 20.5 ml/m²	+2.4 ± 7.6%

LV end-systolic volume index (LVESVI) absolute change

Vericiguat−3.8 ± 15.4 ml/m²

Placebo−7.1 ± 20.5 ml/m²

LV ejection fraction (LVEF) absolute change

Vericiguat+3.2 ± 8.0%

Placebo+2.4 ± 7.6%

Vericiguat vs Placebo: P = 0.07 — LVESVI change
Vericiguat vs Placebo: P = 0.31 — LVEF change

Vericiguat: LVESVI 60.7 ± 26.8 to 56.8 ± 30.4 ml/m²: P < 0.01
Vericiguat: LVEF 33.0 ± 9.4% to 36.1 ± 10.2%: P < 0.01

Further findings

HF hospitalisation or CV death (rate per 100 patient-years) · 8 months · tended to be lower with vericiguat

P = 0.07

Vericiguat19.8 per 100 patient-years

Placebo29.6 per 100 patient-years

Original publication

Effect of Vericiguat on Left Ventricular Structure and Function in Patients with Heart Failure with Reduced Ejection Fraction: The VICTORIA Echocardiographic Substudy. Eur J Heart Fail. Published 18 April 2023. doi:10.1002/ejhf.2836

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