This is a randomised controlled trial to determine the effectiveness of Vericiguat to improve stress myocardial blood flow (MBF) and myocardial perfusion reserve as measured by cardiac magnetic resonance (CMR) imaging.
Stable recurrent chest pain.
40 to 75 years old.
Have coronary computed tomography (CT) angiogram or catheter coronary angiogram within 6 months showing non-obstructive coronary artery disease (<50% coronary artery stenosis or fractional flow reserve >0.8).
Stress CMR MPR <2.19 12 or Stress MBF <2.19ml/g/min 13.
Systolic blood pressure <100 mm Hg.
Concurrent use of soluble guanylate cyclase stimulators (eg. Riociguat), or phosphodiesterase type 5 inhibitors (eg. vardenafil, tadalafil, and sildenafil).
Has known allergy or sensitivity to any soluble guanylate cyclase stimulator.
On long-acting nitrates (eg. isosorbide mononitrate)
Parallel
Vericiguat
DrugPatients will be prescribed vericiguat once a day for 6 months, starting at 2.5mg and titrated up to the full dose of 10mg per day (doubling of dose every 2 weeks) in addition to optimised medical therapy and standard follow-up like the control group
Stress Cardiac Magnetic Resonance
Diagnostic testAll patients will have stress CMR examinations at recruitment and at the end of trial.
Difference in stress myocardial blood flow (MBF)
Difference in stress MBF as measured by stress CMR between patients receiving Vericiguat and patients not receiving Vericiguat
Difference in stress myocardial perfusion reserve (MPR)
Difference in stress MPR as measured by stress CMR between patients receiving Vericiguat and patients not receiving Vericiguat
Improvement in exercise tolerance through performing a cardiopulmonary exercise test.
Measured by baseline and end of study 6-minute walk test
Progression in patient symptoms diagnoses.
The Seattle Angina Questionnaire (SAQ-7) scores are transformed to a range of 0-100, in which higher scores reflect better health status. The measurement will take place at time of baseline CMR and at follow-up CMR in order to determine if there is an improvement in patient symptoms.
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