Physicians' Academy for Cardiovascular Education

sGC stimulator beneficial in HFrEF patients up to NT-proBNP levels of 8000 pg/mL

N-Terminal Pro-B-Type natriuretic Peptide and Clinical Outcomes: Vericiguat Heart Failure With Reduced Ejection Fraction Study

Literature - Ezekowitz JA, O’Connor CM, Troughton RW, et al. - JACC Heart Fail. 2020; 8(11):931-939. doi: 10.1016/j.jchf.2020.08.008.

Introduction and methods

The VICTORIA (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction) trial showed a reduction in the primary outcome of CV death or hospitalization due to HF with the soluble guanylate cyclase (sGC) stimulator vericiguat compared to placebo in patient with worsening HFreEF . A subanalysis demonstrated that patients within the highest quartile of baseline NT-proBNP (>5.314 pg/ml) appeared to have less benefit from vericiguat, while patients in the three lower baseline NT-proBNP quartiles derived greater benefit from this treatment [1].

The current study further assessed the NT-proBNP subgroup outcome of the VICTORIA trial on the primary and individual outcomes and explored the treatment effects of vericiguat in relation to NT-proBNP levels, using NT-proBNP as a log-transformed continuous parameter.

In the VICTORIA trial, participants with worsening chronic HF (NYHA class II to IV), LFEV <45%, elevated natriuretic peptide levels, and recent HF decompensation, were randomized (1:1) to vericiguat or placebo. Patients in sinus rhythm had to have a BNP level of ≥300 pg/ml or NT-proBNP of ≥1000 pg/ml and patients with atrial fibrillation had to have a BNP level of ≥500 pg/ml or NT-proBNP of ≥1600 pg/ml. The primary outcome was a composite of CV death or hospitalization for HF. Secondary outcomes were the individual components of the primary outcome. NT-proBNP was measured in 4805 patients, who were included in the current analysis. Cut points were estimated from the treatment effect of vericiguat across the spectrum of NT-proBNP in which the upper confidence limit did not include 1.00 (at 4000 pg/mL) and below which the point estimate of the treatment effect was <1.00 (at 8000 pg/mL).

Main results


High-risk HFrEF patients with NT-proBNP levels up to 8000 pg/ml in the VICTORIA trial, had a reduced risk on the primary outcome CV death and hospitalization for HF as well as individual outcomes when treated with the sGC stimulator vericiguat.


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Find this article online at JACC Heart Fail.

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