Associazione Nazionale Medici Cardiologi Ospedalieri

CONGRESS ABSTRACT

CONGRESS ABSTRACT

Guanylate cyclase/cGMP axis and cardiovascular/renal structure and function: a physiopathological insight

De Feo Daniele Bari (BA) – Cardiology Section, Hospital “F. Perinei” Altamura (BA), Italy | Ciccone Marco Matteo Bari (BA) – Cardiology Section, University of Bari, Bari, Italy | Caldarola Pasquale Bari (BA) – Cardiology Department, ASL Bari, Bari, Italy | De Palo Micaela Bari (BA) – Cardiac Surgery Section, University of Bari, Bari, Italy | Caragnano Vito Bari (BA) – Cardiology Section, Mater Dei Hospital, Bari Italy | Sassara Marco Bari (BA) – Cardiology Department, San Paolo Hospital, Bari, Italy | Massari Francesco Bari (BA) – Cardiology Section, Hospital “F. Perinei” Altamura (BA), Italy | Scicchitano Pietro Bari (BA) – Cardiology Section, Hospital “F. Perinei” Altamura (BA), Italy

The role of nitric oxide (NO), soluble guanylate cyclase (sGC), and cyclic guanosine monophosphate (cGMP) pathway in cardiovascular and renal health and disease is a challenging issue. The impact of this biochemical way on the vascular tree is well-established: the activation of sGC via NO is able to promote vasodilation and modulation of vascular tone. Indeed, further characteristics lay behind it, hence many studies underscore its pleiotropic influence on functional activities and on structural characteristics of human tissues and cells. Recently, Vericiguat, a sGC-stimulator that increases sGC activation induced by nitric oxide, has been demonstrated to have a relevant clinical efficacy in patients with worsening heart failure with reduced ejection fraction (HFrEF) by ameliorating cardiovascular (CV) death risk, re-hospitalization for HF, and all-cause mortality. Results from phase III trials demonstrated that prompt administration of vericiguat after acute HF decompensation significantly improved life-expectancy as demonstrated by a number-needed-to-treat equal to 24. These new data on the efficacy of NO-sGC-cGMP axis stimulation in several clinical outcomes increased the interest in understanding the other possible physio-pathological mechanisms, different respect to the old-fashioned theories regarding the dilation of vascular tree, which may definitively explain the results from recent studies. The NO-sGC-cGMP axis, in fact, might impact on endothelial function, kidney performance, and cardiac muscular cells activity: the synergy of these actions might explain the positive effects of vericiguat in worsening HF. The aim of this narrative review was to provide a full insight in physio-pathologic modes of action of NO-sGC-cGMP axis stimulators on cardiac muscle, endothelial cells, and kidneys.