维利西呱对四级心衰有效果吗？

Vericiguat is effective in grade IV heart failure. It can improve dyspnea, fatigue, peripheral edema, palpitations, skin and mucous membrane cyanosis and other symptoms caused by heart failure. It can delay the progression of heart failure and reduce mortality.

Patients with grade IV (Grade IV) heart failure cannot engage in any physical activity. Heart failure symptoms also exist at rest and worsen after activity.

Viricigua

It is a stimulator of soluble ornitrate cyclase (sGC), a second messenger that plays a role in regulating vascular tone, myocardial contractility, and cardiac remodeling.

Heart failure is associated with impaired NO synthesis and reduced SGC activity, which can lead to myocardial and vascular dysfunction. By directly stimulating sGC, independent of nitric oxide, and working in conjunction with nitric oxide, veliciguat increases intracellular CGMP levels, causing smooth muscle relaxation and vasodilation.

Viricigua's

In a phase 3 randomized, double-blind, placebo-controlled trial, 5050 patients with chronic heart failure and an ejection fraction less than 45% were assigned to veliciguat (target dose, 10 mg once daily) or placebo, along with guideline-based medical therapy.

Over a median time of 10.8 months, a major outcome event occurred in 35.5% of patients in the velicigat group and 38.5% in the placebo group. 27.4% of patients in the veliciguat group and 29.6% in the placebo group were hospitalized for heart failure.

16.4% of patients in the veliciguat group and 17.5% of patients in the placebo group died of cardiovascular disease. 37.9% of patients in the veliciguat group died from any cause or were hospitalized for heart failure, compared with 40.9% in the placebo group.

Among patients with high-risk heart failure, those who received veliciguat had significantly lower rates of death from cardiovascular causes or hospitalization for heart failure than those who received placebo.

Clinical trials have shown that veliciguat is beneficial in high-risk heart failure patients, and may be considered for individual patients with heart failure and reduced left ventricular ejection fraction (HFrEF), especially those with a higher risk of heart failure hospitalization.

The recommended starting dose of veliciguat is 2.5 mg once daily, taken with food, with the dose of veliciguat doubled approximately every 2 weeks to achieve a target maintenance dose of 10 mg once daily as tolerated. The most common adverse reactions reported in >5% during treatment were hypotension and anemia.

References:

Armstrong PW, Pieske B, Anstrom KJ, Ezekowitz J, Hernandez AF, Butler J, Lam CSP, Ponikowski P, Voors AA, Jia G, McNulty SE, Patel MJ, Roessig L, Koglin J, O'Connor CM; VICTORIA Study Group. Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2020 May 14;382(20):1883-1893. doi: 10.1056/NEJMoa1915928. Epub 2020 Mar 28. PMID: 32222134.

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