Short-term right heart reverse remodeling with vericiguat in HFrEF: reductions in pulmonary arterial pressure and chamber dimensions

Background Heart failure is the end-stage of various cardiovascular diseases. Although a variety of drugs have slowed down the progression of the disease, the prognosis of heart failure patients remains unsatisfactory. Vericiguat can improve left ventricular function, but there is relatively less research on its effect on right ventricular function. This study aimed to evaluate whether vericiguat can improve the right ventricular function of heart failure patients. Methods Patients with left ventricular ejection fraction < 45% who were hospitalized for the first time in the Department of Cardiology, The Second Affiliated Hospital of Soochow University from January 1, 2023, to December 31, 2024 were included and divided into two groups. The baseline and 3-month follow-up clinical characteristics, laboratory data, routine transthoracic echocardiogram parameters, and medication use of patients were collected. Results A total of 90 eligible patients were finally included, with 60 cases in the vericiguat group and 30 cases in the control group. In the vericiguat group, right ventricular function improved significantly after treatment. The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio increased significantly [0.51 ± 0.22 vs. 0.60 ± 0.22, p = 0.001]. Right atrial longitudinal dimension index significantly decreased [30.07 ± 5.80 mm/m 2 vs. 28.57 ± 5.43 mm/m 2 , p = 0.001], as did the Right atrial transverse dimension index [23.21 ± 5.13 mm/m 2 vs. 21.86 ± 4.40 mm/m 2 , p = 0.012] and right ventricular basal diameter index [22.48 ± 3.96 mm/m 2 vs. 21.07 ± 3.59 mm/m 2 , p < 0.001]. Pulmonary arterial systolic pressure decreased significantly [41.47 ± 16.25 mmHg vs. 36.20 ± 14.32 mmHg, p = 0.006]. In the control group, no significant changes were observed in right heart function parameters. Multiple linear regression analysis showed that the increase in ΔTAPSE/PASP was not significantly associated with changes in left ventricular function. Conclusions Vericiguat treatment was associated with a reduction in pulmonary artery systolic pressure, improves right ventricle-pulmonary artery coupling, and promotes structural reverse remodeling of the right atrium and right ventricle in heart failure patients. These right heart benefits occur independently of changes in left ventricular structure and function. Vericiguat showed good short-term safety.