# Sacubitril/valsartan versus enalapril bij Chagas-hartfalen

*geplaatst 2026-01-06 · Hartfalen · JAMA · doi 10.1001/jama.2025.19808 · https://hartvaat.nl/2026/01/06/sacubitril-valsartan-versus-enalapril-bij-chagas-hartfalen/*

Multicenter trial vergeleek ARNI met enalapril bij hartfalen door Chagas-ziekte. De eerste RCT specifiek bij deze unieke HF-etiologie vult een belangrijke kennislacune.

## English: Sacubitril/Valsartan vs Enalapril in Heart Failure Due to Chagas Disease: An Open-Label, Multicenter Randomized Clinical Trial.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: JAMA, https://doi.org/10.1001/jama.2025.19808. Bijgewerkt 2026-07-03T13:31:05Z. 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.