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Vasospastic AnginaPhase 2ViVANCT06415227

The Impact of Vericiguat on Microvascular Function in Patients With Documented Vasospastic Angina Pectoris

A Phase 2 study testing Vericiguat in people with Vasospastic Angina, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) at 1 site in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Vasospastic angina is increasingly recognized as an important contributor to anginal symptoms in patients with non-obstructive coronary artery disease (ANOCA). Endothelial dysfunction and smooth muscle cell dysfunction are considered elementary in the development of vasospastic angina. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Vasospastic Angina
What is being tested?
Vericiguat
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
57 participants
Where
1 siteNetherlands
Study dates
10 Feb 2025to 13 Jul 2026
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age >18 years
  • Recurrent angina symptoms provoked by exercise and/or repeated attacks of angina at rest at least once weekly despite current medical treatment.
  • Absence of (co-existing) flow-limiting coronary artery stenosis (as defined by any coronary artery diameter reduction >50%, or fractional flow reserve≤0.80, or instantaneous wave-free ratio/resting full cycle ratio ≤0.89).
  • Unambiguous epicardial and/or microvascular coronary vasospasm according to the COVADIS criteria, documented by invasive acetylcholine provocation testing.
  • A female participant is eligible to participate if at least one of the following conditions applies: Women with a confirmed post-menopausal state (defined as amenorrhea for at least 12 months without an alternative medical cause); or premenopausal women with documented hysterectomy, documented bilateral salpingectomy or documented bilateral oophorectomy; or for women of childbearing potential: Negative highly sensitive urine or serum pregnancy test within 24 hours the first dose of study intervention and practicing a highly effective birth control method (failure rate of less than 1%) during the study intervention period / and for at least one month after the last dose of study intervention: progestogen-only subdermal contraceptive implant, intrauterine system (progestin releasing intrauterine device), non-hormonal intrauterine device, bilateral tubal occlusion, azoospermic partner (vasectomized or secondary to medical cause) or heterosexual abstinence.

Who cannot join

  • Impaired left ventricular function (LVEF<50%)
  • Significant valvular pathology
  • Contraindication for treatment with sublingual nitrates as background medication only, at the discretion of the treating cardiologist.
  • Contraindications for treatment with vericiguat: resting systolic blood pressure<100mmHg, severe renal impairment (estimated glomerular filtration rate <15ml/min), severe hepatic impairment.
  • Known hypersensitivity to the active substance or to any of the excipients (Microcrystalline cellulose, croscarmellose sodium, hypromellose 2910, lactose monohydrate, magnesium stearate, sodium laurilsulfate).
  • Concomitant use of other soluble guanylate cyclase (sGC) stimulators, such as riociguat.
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  • Concomitant use PDE5 inhibitors, such as sildenafil.
  • Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.
  • Patients who are pregnant or nursing and those who plan pregnancy in the period up to 1 month after the study;
  • Patients with a limited life expectancy less than one year;
  • Patients unable to provide written informed consent, or are otherwise not suitable for inclusion according to the investigator

Trial locations and contacts

1 site in 1 country.

Netherlands1 site
  • Amsterdam UMC

    Amsterdam

Other trials in Netherlands

About this study

Official title: Vericiguat in Vasospastic Angina

Vasospastic angina is increasingly recognized as an important contributor to anginal symptoms in patients with non-obstructive coronary artery disease (ANOCA). Endothelial dysfunction and smooth muscle cell dysfunction are considered elementary in the development of vasospastic angina. As one of many functions, the vascular endothelium regulates local vascular tone, mainly through the vasodilatory effect of endothelium-derived nitric oxide (NO). Vericiguat is a soluble guanylate cyclase (sGC) stimulator and thereby acts directly on the NO signalling pathway from the endothelium towards the vascular smooth muscle cells. As such, Vericiguat potentially has an beneficial therapeutic effect in patients with vasospastic angina.The VIVA study aims to demonstrate the effect of Vericiguat on endothelial function and microvascular vasodilator responses, as well as its tolerability and safety in patients with vasospastic angina as the pathophysiological substrate of ANOCA.

Being tested
Vericiguat
Medical subject headings
Angina Pectoris, Variant

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • VericiguatDrug

    Also called Verquvo

    The target dose of vericiguat is 10 milligrams once daily, which will be started at 2.5mg once daily and uptitrated every two weeks to reach the target dose. Dose modification will depend on mean sitting systolic blood pressure and the absence of symptoms indicative of hypotension. The intention of the protocol is to reach and maintain the target study drug dose after completion of uptitration. If the dose is temporarily interrupted, then resumption of study drug treatment and continued uptitration will be considered at any subsequent visit when the investigator feels it is medically appropriate. Vericiguat will be taken orally once daily at about the same time.

Study groups in NCT06415227
Study groupRoleWhat they receive
Vericiguat (2.5 mg, 5 mg and 10 mg) first; placebo secondExperimentalTreatment with Vericiguat will be uptitrated every two weeks to the highest tolerated dose, with a target maintenance dose of maximum 10 mg once daily. After a washout period of 2 weeks, matching placebo will be started and is uptitrated every two weeks to maintain double blinding.
Receives: Drug: Vericiguat
Placebo first; Vericiguat (2.5 mg, 5 mg and 10 mg) secondPlacebo comparatorMatching placebo is uptitrated every two weeks to maintain double blinding. After a washout period of 2 weeks, treatment with Vericiguat will be started and is uptitrated every two weeks to the highest tolerated dose, with a target maintenance dose of maximum 10 mg once daily.
Receives: Drug: Vericiguat

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Microvascular function assessed with LASCA : Area under the curve for cutaneous microvascular conductance during acetylcholine iontophoresis

    Difference in area under the curve for cutaneous microvascular conductance in APU/s during acetylcholine iontophoresis after 10-week placebo- versus 10-week vericiguat treatment periods

    Measured: 10-week and 22-week follow-up

Secondary outcomes (29)
  1. Microvascular function assessed with LASCA : Peak cutaneous microvascular conductance during acetylcholine iontophoresis

    Difference in peak cutaneous microvascular conductance in APU/mmHg during acetylcholine iontophoresis after 10-week placebo- versus 10-week vericiguat treatment periods

    Measured: 10-week and 22-week follow-up

  2. Microvascular function assessed with LASCA : Absolute and relative change in cutaneous microvascular conductance (peak-baseline) during acetylcholine iontophoresis.

    Difference in the absolute and relative change in cutaneous microvascular conductance from baseline conditions to peak conductance during acetylcholine iontophoresis in APU/mmHg after 10-week placebo- versus 10-week vericiguat treatment.

    Measured: 10-week and 22-week follow-up

  3. Vasodilator function assessed with EndoPAT.

    Difference in vasodilator function assessed with EndoPAT after 10-week placebo versus 10-week vericiguat treatment expressed by the Reactive hyperemia index (RHI), calculated as the index of signal amplitude pre-to-post occlusion in the occluded arm, divided by the same ratio in the control arm.

    Measured: 10-week and 22-week follow-up

  4. Microvascular function assessed with LASCA on placebo versus vericiguat treatment using SNP and insulin.

    Difference in cutaneous microvascular conductance in APU/mmHg during SNP or insulin iontophoresis after 10-week placebo- versus 10-week vericiguat treatment periods

    Measured: 10-week and 22-week follow-up

  5. Microvascular function assessed with LASCA on placebo versus vericiguat treatment using SNP and insulin.

    Difference in the area under the curve for cutaneous microvascular conductance in APU/s during SNP or insulin iontophoresis after 10-week placebo- versus 10-week vericiguat treatment periods

    Measured: 10-week and 22-week follow-up

  6. Microvascular function assessed with LASCA stratified by the vericiguat dose reached during the treatment

    Difference in peak cutaneous microvascular conductance in APU/mmHg after 10-week placebo versus 10-week vericiguat treatment stratified by the vericiguat dose reached during the treatment phase (5 or 10mg).

    Measured: 10-week and 22-week follow-up

  7. Microvascular function assessed with LASCA stratified by the vericiguat dose reached during the treatment

    Difference in area under the curve for cutaneous microvascular conductance in APU/s after 10-week placebo versus 10-week vericiguat treatment stratified by the vericiguat dose reached during the treatment phase (5 or 10mg).

    Measured: 10-week and 22-week follow-up

  8. Microvascular function assessed with LASCA stratified by the vericiguat dose reached during the treatment

    Difference in absolute and relative changes in cutaneous microvascular conductance in APU/mmHg after 10-week placebo versus 10-week vericiguat treatment stratified by the vericiguat dose reached during the treatment phase (5 or 10mg).

    Measured: 10-week and 22-week follow-up

  9. Vasodilator function assessed with EndoPAT stratified by the vericiguat dose reached during the treatment

    Difference in reactive hyperemia index (RHI) after 10-week placebo versus 10-week vericiguat treatment stratified by the vericiguat dose reached during the treatment phase (5 or 10mg). RHI is calculated as the index of signal amplitude pre-to-post occlusion in the occluded arm, divided by the same ratio in the control arm.

    Measured: 10-week and 22-week follow-up

  10. Microvascular function assessed with LASCA stratified by epicardial or microvascular vasospasm endotype.

    Difference in peak cutaneous microvascular conductance in APU/mmHg after 10-week placebo versus 10-week vericiguat treatment stratified by epicardial or microvascular vasospasm endotype.

    Measured: 10-week and 22-week follow-up

  11. Microvascular function assessed with LASCA stratified by epicardial or microvascular vasospasm endotype.

    Difference in area under the curve for cutaneous microvascular conductance in APU/s after 10-week placebo versus 10-week vericiguat treatment stratified by epicardial or microvascular vasospasm endotype.

    Measured: 10-week and 22-week follow-up

  12. Microvascular function assessed with LASCA stratified by epicardial or microvascular vasospasm endotype.

    Difference in absolute and relative changes in cutaneous microvascular conductance in APU/mmHg after 10-week placebo versus 10-week vericiguat treatment stratified by epicardial or microvascular vasospasm endotype.

    Measured: 10-week and 22-week follow-up

  13. Vasodilator function assessed with EndoPAT stratified by epicardial or microvascular vasospasm endotype.

    Difference in reactive hyperemia index (RHI) after 10-week placebo versus 10-week vericiguat treatment stratified by epicardial or microvascular vasospasm endotype. RHI is calculated as the index of signal amplitude pre-to-post occlusion in the occluded arm, divided by the same ratio in the control arm.

    Measured: 10-week and 22-week follow-up

  14. Quality of life between vericiguat treatment and placebo

    Difference in quality of life measured by the ORBITA-2 application after 10-week placebo versus 10-week vericiguat treatment periods.

    Measured: 10-week snd 22-week follow-up

  15. Quality of life between vericiguat treatment and placebo

    Difference in quality of life measured by the Seattle Angina Questionnaire (SAQ) Summary Score after 10-week placebo versus 10-week vericiguat treatment periods. The SAQ summary score ranges from 0 to 100 with higher scores indicating less angina, fewer functional limitations, and better quality of life.

    Measured: 10-week and 22-week follow-up

  16. Quality of life between vericiguat treatment and placebo

    Difference in quality of life measured by the Rose Dyspnea Score after 10-week placebo versus 10-week vericiguat treatment periods. The Rose Dyspnea Scale is a four-item questionnaire that assesses a patients' dyspnea level with common activities. One point is assigned to each activity associated with dyspnea. Scores range from 0 to 4, where 0 indicates no dyspnea with activity and 4 indicates significant limitations due to dyspnea.

    Measured: 10-week and 22-week follow-up

  17. Quality of life between vericiguat treatment and placebo

    Difference in quality of life measured by EQ-5D-5L (EuroQol - 5 dimensions - 5 levels. A self-assessed, health-related, quality of life questionnaire) scores after 10-week placebo versus 10-week vericiguat treatment periods. The five severity levels in the EQ-5D-5L are 'no problems', 'slight problems', 'moderate problems', 'severe problems' and 'unable to/extreme problems'.

    Measured: 10-week and 22-week follow-up

  18. Quality of life between vericiguat treatment and placebo

    Difference in quality of life measured by the EQ visual analogue scale (EQ-VAS) scores after 10-week placebo versus 10-week vericiguat treatment periods. The EQ VAS component contains a scaled vertical line ranging from 0 ('the worst health you can imagine') to 100 ('the best health you can imagine') where respondents rate their overall health status.

    Measured: 10-week and 22-week follow-up

  19. Quality of life between vericiguat treatment and placebo

    Difference in quality of life measured by iPCQ (iMTA (Institute for Medical Technology Assessment) Productivity Cost Questionnaire) index score after 10-week placebo versus 10-week vericiguat treatment periods. The scoring of the iPCQ questionnaire involves three modules assessing productivity losses due to absenteeism (1), presenteeism (2), and productivity losses associated with unpaid work (3). Scores are calculated in costs with a higher score indicating higher productivity loss.

    Measured: 10-week and 22-week follow-up

  20. Quality of life between vericiguat treatment and placebo

    Difference in quality of life measured by iMCQ (iMTA (Institute for Medical Technology Assessment) Medical Consumption Questionnaire) index score after 10-week placebo versus 10-week vericiguat treatment periods. The scoring of the iMCQ questionnaire involves calculating medical consumption by assessing respondents' answers to relevant questions, which inquire about various forms of care and the frequency of their utilization. A higher score indicates higher health care consumption.

    Measured: 10-week and 22-week follow-up

  21. Quality of life between baseline and end of treatment

    Difference in the change in quality of life measured by the ORBITA-2 application from baseline (prior to randomization) to 10-week placebo and 10-week vericiguat treatment periods.

    Measured: 10-week and 22-week follow-up

  22. Quality of life between baseline and end of treatment

    Difference in the change in quality of life measured by the Seattle Angina Questionnaire (SAQ) Summary Score from baseline (prior to randomization) to 10-week placebo and 10-week vericiguat treatment periods. The SAQ summary score ranges from 0 to 100 with higher scores indicating less angina, fewer functional limitations, and better quality of life.

    Measured: 10-week and 22-week follow-up

  23. Quality of life between baseline and end of treatment

    Difference in the change of quality of life measured by the Rose Dyspnea Score from baseline (prior to randomization) to 10-week placebo and 10-week vericiguat treatment periods. The Rose Dyspnea Scale is a four-item questionnaire that assesses a patients' dyspnea level with common activities. One point is assigned to each activity associated with dyspnea. Scores range from 0 to 4, where 0 indicates no dyspnea with activity and 4 indicates significant limitations due to dyspnea.

    Measured: 10-week and 22-week follow-up

  24. Quality of life between baseline and end of treatment

    Difference in the change of quality of life measured by the EQ-5D-5L (EuroQol - 5 dimensions - 5 levels. A self-assessed, health-related, quality of life questionnaire) scores from baseline (prior to randomization) to 10-week placebo and 10-week vericiguat treatment periods.The five severity levels in the EQ-5D-5L are 'no problems', 'slight problems', 'moderate problems', 'severe problems' and 'unable to/extreme problems'.

    Measured: 10-week and 22-week follow-up

  25. Quality of life between baseline and end of treatment

    Difference in the change of quality of life measured by the EQ visual analogue scale (EQ-VAS) scores from baseline (prior to randomization) to 10-week placebo and 10-week vericiguat treatment periods.The EQ VAS component contains a scaled vertical line ranging from 0 ('the worst health you can imagine') to 100 ('the best health you can imagine') where respondents rate their overall health status.

    Measured: 10-week and 22-week follow-up

  26. Quality of life between baseline and end of treatment

    Difference in the change of quality of life measured by the iPCQ (iMTA (Institute for Medical Technology Assessment) Productivity Cost Questionnaire) index score from baseline (prior to randomization) to 10-week placebo and 10-week vericiguat treatment periods. The scoring of the iPCQ questionnaire involves three modules assessing productivity losses due to absenteeism (1), presenteeism (2), and productivity losses associated with unpaid work (3). Scores are calculated in costs with a higher score indicating higher productivity loss.

    Measured: 10-week and 22-week follow-up

  27. Quality of life between baseline and end of treatment

    Difference in the change of quality of life measured by the iMCQ (iMTA (Institute for Medical Technology Assessment) Medical Consumption Questionnaire) index score from baseline (prior to randomization) to 10-week placebo and 10-week vericiguat treatment periods. The scoring of the iMCQ questionnaire involves calculating medical consumption by assessing respondents' answers to relevant questions, which inquire about various forms of care and the frequency of their utilization. A higher score indicates higher health care consumption.

    Measured: 10-week and 22-week follow-up

  28. Angina burden

    Angina burden calculated by the frequency of angina attacks for placebo versus vericiguat treatment periods

    Measured: 10-week and 22-week follow-up

  29. The occurrence of major adverse cardiac events

    The occurrence of major adverse cardiac events (hospitalization for angina, spontaneous myocardial infarction, unplanned revascularization, death) during the study period.

    Measured: 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 May 2024
  2. Study start10 Feb 2025
  3. Primary completion13 Jul 2026
  4. Study completion13 Jul 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
57 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06415227
Sponsor's protocol ID
EU CT 2022-502998-42-00
Acronym
ViVA
Status last verified
Jul 2026
First submitted
25 Apr 2024
Last updated
29 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Namba HF, de Jong EAM, Dimitriu-Leen AC, Meuwissen M, Heestermans TACM, den Haan MC, Beijk MAM, Vos NS, Boerhout CKM, Mechroubi A, Nijkamp T, Mohsin M, Escaned J, den Ruijter HM, Appelman Y, Vink AS, Eringa EC, Delewi R, Piek JJ, Damman P, van de Hoef TP. Vericiguat for the Treatment of Coronary Vasospasm (ViVA): A Double-Blind Placebo-Controlled Randomized Crossover Trial. J Am Coll Cardiol. 2026 Aug 28:S0735-1097(26)07591-1. doi: 10.1016/j.jacc.2026.08.037. Online ahead of print.

    PubMed 42670734
  • Namba HF, de Jong EAM, Boerhout CKM, Mechroubi A, Nijkamp T, Damman P, Dimitriu-Leen AC, Meuwissen M, Heestermans TACM, den Haan MC, Beijk MAM, Vos NS, Escaned J, den Ruijter HM, Appelman Y, Eringa EC, Delewi R, Piek JJ, van de Hoef TP. Rationale and design of the vericiguat in vasospastic angina (ViVA) trial: A double-blind placebo-controlled randomized cross-over study. Am Heart J. 2026 Sep;299:107451. doi: 10.1016/j.ahj.2026.107451. Epub 2026 Apr 23.

    PubMed 42034271

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Vericiguat in people with Vasospastic Angina, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) at 1 site in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Microvascular function assessed with LASCA : Area under the curve for cutaneous microvascular conductance during acetylcholine iontophoresis (time frame: 10-week and 22-week follow-up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06415227, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2026.

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