Vericiguat VICTORIA Trial — EECC MCQ

Correct answer: B — Vericiguat is a soluble guanylate cyclase (sGC) stimulator that enhances the NO-sGC-cGMP pathway; VICTORIA showed a modest reduction in HF hospitalisation and CV death in patients with HFrEF and recent worsening HF event, despite being on GDMT

Vericiguat is a soluble guanylate cyclase (sGC) stimulator that enhances the deficient NO-sGC-cGMP signalling pathway in HF. Unlike riociguat (which is used in PH), vericiguat is indicated for HFrEF. The VICTORIA trial (2020) enrolled 5,050 patients with HFrEF (LVEF <45%) and a recent worsening HF event (hospitalisation within 6 months or IV diuretic use within 3 months). Results: 10% relative risk reduction in the composite of CV death or first HF hospitalisation (p=0.02). The benefit was more modest than other GDMT agents, and the trial enrolled patients already on GDMT (though SGLT2i use was low at ~15%). The ESC 2023 HF Guidelines include vericiguat as a consideration (Class IIb) for patients who continue to worsen despite optimal quadruple therapy.

Reference: ESC (2023): HF Guidelines; VICTORIA Trial