Clinical profile, associated events and safety of vericiguat in a real-world cohort: The VERITA study.

AIMS: The aim of this study was to determine the clinical profile, associated events and safety of vericiguat in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF). METHODS: This study is a prospective and observational cohort study of patients with HFrEF and recent HF worsening episodes requiring intravenous therapy who initiated vericiguat in an HF outpatient clinic. A subanalysis of patients with ≥6 months' follow-up was performed separately. RESULTS: Out of 103 patients initially included, 52 had a follow-up of at least 6 months (median follow-up of 303 days). At baseline, the mean age was 71.3 ± 9.4 years, 27.2% were women, the median left ventricular ejection fraction was 34% (28%-39%) and 99% were taking beta-blockers, 96.1% sodium-glucose cotransporter-2 (SGLT2) inhibitors, 95.1% sacubitril-valsartan, 90.3% aldosterone antagonists and 93.2% loop diuretics. During follow-up, New York Heart Association (NYHA) functional class improved (from 67.3% and 32.7% in classes III and II, respectively, to 22.4% and 75.5% at study end; P < 0.001), as did the EuroQol-5D (EQ-5D) and visual analogue scale (VAS) scores (from 0.83 ± 0.13 to 0.87 ± 0.12, P = 0.032, and from 60 to 79, P = 0.005, respectively). Vericiguat was well tolerated (13.5% had symptomatic hypotension, and 11.5% had discontinued treatment), and 78.8% of patients achieved the target dose of 10 mg. The number of HF-related hospitalizations/decompensations within the previous 12 months was 2.3 ± 1.4 and decreased with vericiguat to 0.79 ± 1.14 (P < 0.001). At study end, 7.7% died (50% for HF). CONCLUSIONS: In clinical practice, treatment with vericiguat is associated with substantial improvements in functional class and quality of life and a reduction in hospitalizations for HF, with a low risk of adverse effects.

Breaking barriers in cardiac donation after circulatory death.

BACKGROUND: Heart transplant (HT) from controlled donation after circulatory death (cDCD) is an emerging strategy that is rapidly expanding and may help increase the heart donor pool. MATERIALS AND METHODS: The use of thoracoabdominal normothermic regional perfusion with extracorporeal membrane oxygenation device has allowed to perform HT after cDCD in our country. We present a successful case of heart transplantation using a graft from cDCD with 201 min cold ischemia time. DISCUSSION AND CONCLUSION: HT from cDCD could be a good alternative to brain dead donation. This experience suggests than nonlocal cardiac from cDCD could tolerate long periods of cold ischemia time and break the main barriers with this technique.

Cognitive effects of dexamethasone at high altitude.

OBJECTIVE: The major therapeutic effect of dexamethasone on persons affected by high-altitude illness may be upon vascular leakiness with a consequent decrease in cerebral edema. We set out to determine if dexamethasone ameliorates the cognitive/psychomotor effects of acute exposure to high altitude on asymptomatic subjects. METHODS: Six adult subjects were tested at baseline (2500 m) with standard, computerized cognitive and psychomotor tests. Over the next 4 days, subjects were acclimatized to an altitude of 3700 m. On the fifth day, subjects ascended to 4800 m where predexamethasone testing was administered. No subject had symptoms of frank altitude illness at 4800 m. To limit acclimatization, subjects descended to 3700 m within 4 hours. The first 4-mg dose of oral dexamethasone was given in the evening of day 5. A second 4-mg dose of dexamethasone was given the following morning, and subjects reascended to 4800 m where postdexamethasone testing was performed. RESULTS: All cognitive and psychomotor tests showed improved reaction times in subjects who were given dexamethasone. Mean reaction time (+/- SD) for shape recognition went from 1.20 +/- 0.36 seconds at 2500 m to 1.40 +/- 0.37 seconds at 4800 m. After dexamethasone administration, mean shape recognition time declined to 1.26 +/- 0.32 seconds (P = .052). CONCLUSION: These data show a trend toward decreased cognitive deficits in subjects pretreated with dexamethasone. One possibility for this trend is that cognitive deficits in otherwise asymptomatic subjects exposed to high altitude are caused by subclinical cerebral edema.