Racial and Ethnic Differences in Biomarkers, Health Status, and Cardiac Remodeling in Patients with Heart Failure with Reduced Ejection Fraction Treated with Sacubitril/Valsartan.

Background: Among patients with heart failure and reduced ejection fraction (HFrEF, left ventricular [LV] EF ≤40%) sacubitril/valsartan (S/V) treatment is associated with improved health status and reverse cardiac remodeling. Data regarding racial and ethnic differences in response to S/V are lacking. Methods: This was an analysis from the Prospective Study of Biomarkers, Symptom Improvement and Ventricular Remodeling During Entresto Therapy for Heart Failure Study. Longitudinal changes in N-terminal pro B-type natriuretic peptide (NT-proBNP), cardiac reverse remodeling, and health status scores were compared between groups using multivariate latent growth curve modeling. Results: Among the 782 patients included in this study, 22.7% were Non-Hispanic Black (from herein referred to as Black), 14.9% were Hispanic, and 62.4% were Non-Hispanic White (from herein referred to as White). At baseline, compared to White patients, Black and Hispanic patients had lower NT-proBNP (g = 0.34) and differences between groups in baseline values for LVEDVi and LVESVi were negligible (g<0.10). Following S/V initiation, NT-proBNP decreased in all three groups (p<.0001) associated with improvements in LVEF, LVEDVi, and LVESVi. Although total improvement in LV measures was similar between groups, Black patients averaged larger gains in the first half of the trial while White patients averaged larger gains in the second half. Improvements in Kansas City Cardiomyopathy Questionnaire-23 Total Symptom scores were seen in all three groups. Treatment with S/V was well-tolerated. Conclusions: Among Black, Hispanic, and White patients with HFrEF, treatment with S/V was associated with similar reduction in NT-proBNP, improvement in health status, and reverse remodeling. More data regarding racial and ethnic responses to HFrEF treatment are needed. Registration: ClinicalTrials.gov; Unique Identifier: NCT02887183.