Vericiguat in Heart Failure – VICTORIA vs VICTOR (ESC 2025)
Vericiguat in Heart Failure – VICTORIA vs VICTOR (ESC 2025)
1. Background
• Vericiguat: a drug that stimulates soluble guanylate cyclase, tested in HFrEF.
• VICTOR trial (ESC 2025): larger, lower-risk patients, follow-up to VICTORIA trial.
2. VICTORIA Trial (2020)
• Enrolled very high-risk HF patients.
• Showed small benefit (~10% event reduction).
• Benefit came mainly from sickest patients.
3. VICTOR Trial (2025)
• Larger, lower-risk group; excluded NT-proBNP >6000 (NT-proBNP = heart stress blood test; higher = worse).
• Most on modern therapy – ARNI, MRA, β-blocker; fewer SGLT2i.
• Neutral result (no benefit, no harm) – P≈0.2.
4. Prespecified Analyses (planned in advance)
• Suggested fewer deaths ,but no ↓ hospitalization.
5. Pooled Analysis (combining trials for bigger picture)
• VICTOR + VICTORIA showed reduction in outcomes.
• But effect was same as VICTORIA alone → no stronger signal despite more patients.
6. Biomarkers NT-proBNP (N-terminal pro–B-type Natriuretic Peptide).
• Useful to identify higher-risk patients.
• Rising NT-proBNP = warning for decompensation (sudden worsening of HF).
7. Clinical Context
• Vericiguat remains a fifth-line option after the 4 pillars (ARNI, SGLT2i, MRA, β-blocker).
• May be useful in high-risk or nonresponder patients.
8. Takeaway
• VICTOR = neutral trial.
• Vericiguat not standard therapy yet, but may still have a role in select HF patients.