Cardiology Division, Massachusetts General Hospital, Boston (N.E.I., A.C., D.B., J.L.J.).
Harvard Medical School, Boston, MA (N.E.I., S.D.S., J.L.J.).
Circ Heart Fail. 2020 Nov;13(11):e007829. doi: 10.1161/CIRCHEARTFAILURE.120.007829. Epub 2020 Oct 3.
Among patients with heart failure and reduced ejection fraction (left ventricular (LV) ejection fraction ≤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.
This was an analysis from the PROVE-HF study (Prospective Study of Biomarkers, Symptom Improvement and Ventricular Remodeling During Entresto Therapy for Heart Failure). Longitudinal changes in NT-proBNP (N-terminal pro-B-type natriuretic peptide), cardiac reverse remodeling, and health status scores were compared between groups using multivariate latent growth curve modeling.
Among the 782 patients included in this study, 22.7% were non-Hispanic Black (from here referred to as Black), 14.9% were Hispanic, and 62.4% were non-Hispanic White (from here referred to as White). At baseline, compared with White patients, Black and Hispanic patients had lower NT-proBNP (=0.34) and differences between groups in baseline values for LV end-diastolic volume index and LV end-systolic volume index were negligible (<0.10). Following S/V initiation, NT-proBNP decreased in all 3 groups (<0.0001) associated with improvements in LV ejection fraction, LV end-diastolic volume index, and LV end-systolic volume index. 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 3 groups. Treatment with S/V was well-tolerated.
Among Black, Hispanic, and White patients with heart failure and reduced ejection fraction, 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 heart failure and reduced ejection fraction treatment are needed. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02887183.
在射血分数降低的心力衰竭患者（左心室射血分数≤40%）中，沙库巴曲缬沙坦（S/V）治疗可改善健康状况并逆转心脏重构。关于 S/V 治疗反应的种族和民族差异的数据尚缺乏。
这是 PROVE-HF 研究（Entresto 治疗心力衰竭期间生物标志物、症状改善和心室重构的前瞻性研究）的一项分析。使用多变量潜在增长曲线模型比较各组之间 NT-proBNP（N 末端 pro-B 型利钠肽）、心脏逆重构和健康状况评分的纵向变化。
在这项研究纳入的 782 例患者中，22.7%为非西班牙裔黑人（以下简称黑人），14.9%为西班牙裔，62.4%为非西班牙裔白人（以下简称白人）。在基线时，与白人患者相比，黑人患者和西班牙裔患者的 NT-proBNP 水平较低（=0.34），且组间 LV 舒张末期容积指数和 LV 收缩末期容积指数的基线值差异可以忽略不计（<0.10）。在开始 S/V 治疗后，所有 3 组患者的 NT-proBNP 均降低（<0.0001），LV 射血分数、LV 舒张末期容积指数和 LV 收缩末期容积指数均得到改善。尽管各组 LV 指标的总改善程度相似，但黑人患者在试验的前半段平均获益较大，而白人患者在试验的后半段平均获益较大。所有 3 组患者的堪萨斯城心肌病问卷-23 总症状评分均得到改善。S/V 治疗的耐受性良好。
在射血分数降低的心力衰竭的黑人、西班牙裔和白人患者中，S/V 治疗与 NT-proBNP 降低、健康状况改善和心脏逆重构相关。需要更多有关心力衰竭和射血分数降低治疗的种族和民族反应的数据。
