{"id":"b4cef83f5632","type":"article","url":"https://hartvaat.nl/2026/01/06/sacubitril-valsartan-versus-enalapril-bij-chagas-hartfalen/","title":"Sacubitril/valsartan versus enalapril bij Chagas-hartfalen","title_en":"Sacubitril/Valsartan vs Enalapril in Heart Failure Due to Chagas Disease: An Open-Label, Multicenter Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"JAMA","doi":"10.1001/jama.2025.19808","source_url":"https://doi.org/10.1001/jama.2025.19808","authors":["Renato D Lopes","Edimar Alcides Bocchi","Luis Eduardo Echeverría","Caroline Demacq","Pedro Gabriel Melo de Barros E Silva","Lilian Mazza Barbosa","Lucas Damiani","Sarfaraz Sayyed","Liandra A F Yoshida","Remo Holanda M Furtado","Carlos A Morillo","Ruben Kevorkian","Felix Ramires","M Cecilia Bahit","Antonio Magaña","Adolfo Chávez-Mendoza","Adegil Henrique Miguel da Silva","Aguinaldo Coelho da Silva","Aguinaldo F Freitas","Alfredo Alejandro Romano","Anne Parneix","Armando Segura","Cesar Cassio Broilo França","Cristian Edgardo Botta","Edileide de Barros","Eduardo Roque Perna","Eleonora Montenegro","Franklin Roberto Quiroz Diaz","Gilson Soares Feitosa-Filho","Graciela Viviana Severini","Israel Molina","Jacqueline Dos Santos Sampaio Miranda","Jorgelina Sala","José Francisco Kerr Saraiva","Justo Carbajales","Lilia Nigro Maia","Luiz Carlos Santana Passos","Marcus Vinicius Simões","Maria da Consolação V Moreira","Maria Carmo P Nunes","Mauro Esteves Hernandes","Miguel Hominal","Raquel Saa Zarandon","Ricardo Leon de la Fuente","Roque Aras","Silméia Garcia Zanati Bazan","Telêmaco Luiz da Silva","Vagner Madrini","Wilson Alves de Oliveira","Wladmir Faustino Saporito","Claudio Gimpelewicz","John J V McMurray"],"significance":7,"published":"2026-01-06","source_date":"2026-01-06","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This multicenter trial compared sacubitril-valsartan with enalapril for heart failure due to Chagas disease, the first randomized evidence for ARNI therapy in this tropical cardiomyopathy unique to Latin America.","created":"2026-07-03T10:32:06Z","updated":"2026-07-03T13:31:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter trial vergeleek ARNI met enalapril bij hartfalen door Chagas-ziekte. De eerste RCT specifiek bij deze unieke HF-etiologie vult een belangrijke kennislacune.","abstract_original":"IMPORTANCE: The efficacy and safety of guideline-recommended treatments for heart failure (HF) are uncertain in patients with Chagas disease. OBJECTIVE: To evaluate the efficacy and safety of the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan in patients with HF with reduced ejection fraction due to Chagas disease. DESIGN, SETTING, AND PARTICIPANTS: From December 10, 2019, through September 13, 2023, patients with HF, confirmed diagnosis of Chagas disease, left ventricular ejection fraction of 40% or less, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) of 600 pg/mL or greater (or B-type natriuretic peptide [BNP] ≥150 pg/mL) or 400 pg/mL or greater (or BNP ≥100 pg/mL) if hospitalized for HF within the previous 12 months were screened at 83 sites in Argentina, Brazil, Colombia, and Mexico. Statistical analysis was conducted between May and July 2025. INTERVENTIONS: Patients were randomized to receive sacubitril/valsartan (target dose, 200 mg twice daily) or enalapril (target dose, 10 mg twice daily), in addition to standard therapy. MAIN OUTCOMES AND MEASURES: The primary end point was a hierarchical composite outcome tested, in order, of death from cardiovascular causes, hospitalization for HF, or relative change in NT-proBNP from baseline to 12 weeks. The primary analysis was done using a win ratio approach. RESULTS: Overall, 462 participants were randomized to receive sacubitril/valsartan and 460 to receive enalapril (mean [SD] age, 64.2 [10.8] years; 387 [42.0%] were female). Over a median (IQR) follow-up of 25.2 (18.4-33.2) months, cardiovascular death occurred in 110 patients (23.8% [18.3% wins in the hierarchical comparison]) in the sacubitril/valsartan group and 117 patients (25.4% [17.5% wins]) in the enalapril group. A total of 102 patients (22.1% [7.7% wins]) in the sacubitril/valsartan group and 111 (24.1% [6.9% wins]) in the enalapril group experienced a first hospitalization for HF. Patients in the sacubitril/valsartan group had a median (IQR) decrease in NT-proBNP of 30.6% (-54.3% to -0.9%) at 12 weeks, leading to 22.5% wins, while those in the enalapril group had a 5.5% (-31.9% to 37.5%) decrease (7.2% wins). The resulting stratified win ratio was 1.52 (95% CI, 1.28-1.82; P < .001) for sacubitril/valsartan compared with enalapril. CONCLUSIONS AND RELEVANCE: In patients with HF with reduced ejection fraction due to Chagas disease, there was no significant difference in clinical outcomes between sacubitril/valsartan and enalapril, but there was a greater reduction in NT-proBNP at 12 weeks in patients in the sacubitril/valsartan group. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04023227."}