Changes in Natriuretic Peptide Levels and Cardiac Structure in Patients Treated With Vericiguat　- VERIFY-HF Registry

Changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cardiac remodeling from baseline to follow-up in patients with heart failure with reduced ejection fraction (HFrEF) treated with vericiguat remain unclear.

The VERIFY-HF registry is a nationwide multicenter retrospective single-arm study of patients with HFrEF newly prescribed vericiguat at 22 hospitals in Japan. In this study, we analyzed baseline and follow-up echocardiography findings of 504 patients. Vericiguat dose-dependently reduced NT-proBNP levels, with a greater reduction in those receiving 7.5 or 10 than ≤5 mg vericiguat (NT-proBNP least-squares geometric mean ratio [3 months/baseline] 0.53 vs. 0.65, respectively; P=0.009). Multivariable analysis revealed that high-dose (7.5 or 10 mg) vericiguat was independently associated with a greater reduction in log-transformed NT-proBNP at 3 months (β=-0.125; 95% confidence interval [CI] -0.247, -0.004; P=0.043). High-dose vericiguat was not significantly associated with changes in left ventricular ejection fraction (LVEF) at 12 months (β=0.53; 95% CI -0.49, 1.6; P=0.30). Overall, reverse remodeling at 12 months was modest (LVEF, +4.7%; left ventricular end-systolic volume index, -6.4 mL/m²) and was predominantly associated with newly initiated β-blockers or renin-angiotensin system inhibitors within 3 months prior to vericiguat administration or prior heart failure hospitalization rather than vericiguat dose.

In this real-world registry study, high-dose vericiguat was associated with sustained dose-dependent reductions in NT-proBNP, but not cardiac reverse remodeling.