Effect of Vericiguat on Pulmonary Artery Pressures in Patients With Heart Failure: Real-World Insights From Pressure Sensor Monitoring

Vericiguat improves outcomes in heart failure (HF) by promoting vasodilation of the systemic and pulmonary arterial beds. Little is known about its impact on pulmonary artery pressure (PAP). We aimed to study this effect using measurements from implanted PAP sensors. A retrospective analysis was performed on patients with HF treated with vericiguat and implanted with CardioMEMS. PAP was followed for 90 days before and after vericiguat initiation. We recorded laboratory values, echocardiographic and hemodynamics before vericiguat initiation. Fifteen patients were included (age 70, 67% men). At baseline, median EF was 27.5%, 42% had RV dysfunction, mildly elevated mean PAP (24 mm Hg) and pulmonary vascular resistance of 1.6 Wood. When comparing the average of measurements 90 days before and after vericiguat, there were no changes in systolic (34 (28-42) versus 33 (30-40), P = 0.4), diastolic (17 (14-20) versus 16 (13-20), P = 0.75), and mean (24 (18-28) versus 23 (19-28), P = 0.55) PAP. We compared average measurements in the 3-week period before starting vericiguat to various 3-week intervals after vericiguat and found no difference. At 90 days, the median loop diuretic dose (Furosemide equivalent) was 40 mg [0-160], compared with 42 mg [0-240] before vericiguat. NTproBNP did not change significantly before and after vericiguat initiation (log(NTproBNP) 3.1 (2.4-3.2) versus 2.9 (2.5-3.1), P = 0.4). In conclusion, vericiguat was well tolerated in stable HF patients with mild pulmonary hypertension, but no significant effect on PAP was observed. Larger studies, including patients with higher PAP, are needed to clarify its impact.