Basics of Heart failure

1. HEART FAILURE
BASIC OF

2. FLOW OF PRESENTATION
 Defination
 Classification
 Stages of heart failure or NYHA Classes
 Diagnosis of heart failure
 Classification of treatment
 Overview on Vericiguat
 VICTORIA trial

3. Defination
Heart failure is a chronic , progressive condition in which the heart muscle is
unable to pump enough blood to meet the body’s needs for blood and oxygen.
Basically , the heart can’t keep up with its workload.
Heart failure based on ejection fraction :
 Heart failure with reduced ejection fraction or systolic heart failure
where ejection fraction is <40%
 Heart failure with mildly reduced ejection fraction
where ejection fraction is between 41-49%
 Heart failure with perserved ejection fraction or diastolic heart failure
where ejection fraction is >50%

4. ACCF/AHA Staging of Heart failure
Stage A
At high risk of heart failure but without structural heart disease or
sympotoms of heart failure
Stage B
Structural heart disease but without signs or sympotoms of heart
failure
Stage C
Structural heart disease with prior or current sympotoms of heart
failure
Stage D
Refractory heart failure requiring specialized interventions

5. Class I
No limitations of physical activity
Class II
Slight limitations of physical activity
Class III
Significant limitations of physical activity
Class IV
Unable to carry out any physical activity without sympotoms of heart
failure or sympotoms of heart failure at rest
NYHA Functional classification

6.  Blood tests
 Chest x-ray
 Electrocardiogram ( ECG )
 Echocardiogram
 Stress test
 Cardiac computerized tomography ( CT ) scan
 MRI
 Coronary angiogram
 Myocardial biopsy
Diagnosis of Heart failure

7. • Angiotensin-converting enzyme (ACE) inhibitors
- enalapril
- lisinopril
- captopril
• Angiotensin II receptor blockers.
- Valsartan
- Candesartan
- Telmisartan
• Beta blockers
- Carvedilol
- Metoprolol
- Bisoprolol
• Diuretics
- Hydrochlorothiazide
Medication used to treat heart failure

8. - furosemide
- spironolactone
• ARNI
- Sacubitral / valsartan
• SGLT2I
- dapagliflozin
- empagliflozin
• sGC stimulators
- riociguat ( adempas )
- vericiguat ( Verquvo )

9. • Vericiguat belongs to class of soluble guanylate cyclase ( sGc )
stimulators
• This oral medication is used to reduce the risk of cardiovascular
death and heart failure hospitalisation following hospitalisation for
hf or need for outpatient iv diuretics in adult with sympotomatic
chronic hf and ejection fraction <45%.
• Available doses of vericiguat 2.5 mg , 5 mg, 10 mg.
• ESC HF guidelines endorse the use of vericiguat in patients with
hfref who have worsening HF despite treatment with GDMT.
• On january 20,2021 vericiguat got approved from the US FDA for the
treatment of heart failure on the basis of VICTORIA trail
Vericiguat (Verquvo)

10. VERICIGUAT directly stimulates sGC(soluble guanylate cyclase),
independently of and synergistically with NO(nitric oxide), to produce
more cGMP( cyclic guanosine monophosphate) leading to smooth
muscle relaxation and vasodilation which may improve cardiac
function.
MOA OF VERICIGUAT

11. • AIM :
To know the effect of vericiguat, a novel oral soluble guanylate cyclase
stimulator, in patients with heart failure and reduced ejection fraction
who had recently been hospitalized or had received intravenous
diuretic therapy is unclear
• Number of patients : 5050
• Study duration – 10.8 months
• With NYHA class of II – IV
• LVEF less than 45%
• Treatment dose 10 mg vs placebo over and above GDMT
• Primary outcome
- composite of cv death and hhf
VICTORIA TRAIL

12. Primary outcome
- Primary outcome occurred in 35.5% ( 897 of 2526 patients ) in
vericiguat group and 38.5% (972 of 2524 patients ) in placebo group
- A total of 691 patients (27.4%) in the vericiguat group and 747
patients (29.6%) in the placebo group were hospitalized for heart
failure
CONCLUSIONS
Among patients with high-risk heart failure, the incidence of death
from cardiovascular causes or hospitalization for heart failure was
lower among those who received vericiguat than among those who
received placebo.