Effects of Vericiguat in Heart Failure with Reduced Ejection Fraction: Do not Forget sST2. Letter Regarding the Article ‘Baseline Features of the VICTORIA (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) Trial’
Bibliographic record
Abstract
We read with interest the paper by Pieske et al.1 describing the baseline characteristics of patients enrolled in the VICTORIA (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) trial. Despite the quite extensive description of patient characteristics at baseline, no information about heart failure (HF) biomarkers other than natriuretic peptides is available. Specifically, data about high-sensitivity cardiac troponin T (hs-cTnT) and soluble suppression of tumorigenesis-2 (sST2) have not been provided, although these biomarkers yield strong and independent prognostic significance beyond natriuretic peptides for the prediction of all-cause and cardiovascular mortality and HF hospitalization in patients with chronic HF, particularly those with HF and reduced ejection fraction (HFrEF). While hs-cTnT will be analysed in a planned post-hoc analysis of the VICTORIA trial, sST2 apparently will not.2 This attitude of study investigators may be related to the results of the SOCRATES-PRESERVED (Soluble Guanylate Cyclase Stimulator in Heart Failure Patients with Preserved Ejection Fraction) trial, where no change in sST2 levels was observed, although this was in line with the overall trend of other cardiac biomarkers in this study population, including natriuretic peptides.3 Conversely, sST2 was not evaluated in the SOCRATES-REDUCED (Soluble Guanylate Cyclase Stimulator in Heart Failure with Reduced Ejection Fraction) trial, which showed a trend towards decline in natriuretic peptides in patients with HFrEF treated with vericiguat,4 thus anticipating the announced positive results of the VICTORIA trial. Notably, sacubitril/valsartan, another agent modulating the natriuretic peptide system, has been reported to decrease sST2 levels in HFrEF,5 therefore it would be particularly interesting to investigate this biomarker in HFrEF patients treated with vericiguat. Soluble ST2 can be easily dosed on the same samples collected for galectin-3, which will be measured in this study.2 Therefore, study investigators might consider dosing also sST2 in patients enrolled in the VICTORIA trial, both at baseline and during follow-up examination, to gain further insight on the prognostic value of this biomarker, and to check if a relationship exists between sST2 levels and benefit from vericiguat therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.020 | 0.021 |
| Insufficient payload (model declined to judge) | 0.005 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".