Efficacy of Vericiguat in the Treatment of Elderly Patients with HF and Its Impact on The TGF-β1/Smad3 Signaling Pathway and Rehospitalization Rate

SUN Guijia; TONG Sen; LI Hui; ZHANG Xiaomin; CHENG Hongjuan; KONG Haibo; FENG Qiang

doi:10.3639/j.issn.2095-3097.2025.03.020

Abstract：Objective To investigate the therapeutic effect of vericiguat in elderly patients with heart failure(HF)and its impact on the transforming growth factor-β1(TGF-β1)/Smad homolog 3(Smad3)signaling pathway and rehospitaliza-tion rate.Methods A total of 106 cases of elderly HF patients who were treated in Handan Central Hospital from November 2022 to January 2024 were selected and assigned to a reference group(conventional anti-HF treatment)and observation group(conventional treatment+vericiguat)according to random number table method,with 53 cases in each group.The efficacy and incidence of adverse reactions were compared between the two groups,as well as the 6-minute walking test(6MWT),cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDD),left ventricular end-dia-stolic volume(EDV)],ventricular structural remodeling indicators[left ventricular mass index(LVMI),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness at the end of diastole(IVSTd)],biochemical indicators[N-terminal pro-B-type natriuretic peptide(NT-proBNP),blood urea nitrogen(BUN),creatinine(Cr),glomerular filtration rate(GFR)],and TGF-β1/Smad3 signaling pathway-related indicators[total TGF-β1 messenger ribonucleic acid(mRNA),Smad3 mRNA]be-fore treatment,and after 3 and 6 months of treatment.After 6-month follow-up,the rehospitalization rate and incidence of adverse cardiovascular events were compared between the two groups.Results The total effective rate of the observation group(94.34%)was higher than that of the reference group(77.36%)(P<0.05).After 3 and 6 months of treatment,LVDD and EDV in the obser-vation group were lower than those in the reference group,and LVEF and 6MWT were higher than those in the reference group.After 3 and 6 months of treatment,NT-proBNP was higher in the observation group than in the reference group,and GFR was higher than those in the reference group(P<0.05).After 3 and 6 months of treatment,LVPWT,LVMI,and IVSTd were lower in the observation group than those in reference group(P<0.05).After 3 and 6 months of treatment,Smad3 mRNA and TGF-β1 mRNA in the observation group were lower than those in the reference group(P<0.05).Comparison of the total incidence of ad-verse reactions in the two groups,the difference is not statistically significant(P>0.05).At 6-month follow-up after treatment,the rate of recurrent HF in the observation group was 4.00%(2/50)and the rate of rehospitalisation was 8.00%(4/50),which were lower than those in the reference group[17.31%(9/52)and 26.92%(14/52)](P<0.05).Conclusion Adding vericiguat to the conventional anti-heart failure treatment regimen can effectively inhibit the expression of TGF-β1 mRNA and Smad3 mRNA,reduce myocardial fibrosis in elderly HF patients,reduce ventricular remodeling,improve cardiac and renal function,enhance efficacy,reduce the recurrence rate of HF and rehospitalisation rate,and is safe and reliable.