{"id":"adf364a18ccd","type":"article","url":"https://hartvaat.nl/2026/03/17/answer-hf-sacubitril-valsartan-versus-enalapril-bij-chagas-hf-primaire-resultate/","title":"ANSWER-HF: sacubitril/valsartan versus enalapril bij Chagas-HF — primaire resultaten","title_en":"Sacubitril-Valsartan vs Enalapril in Heart Failure Due to Chagas Disease: Primary Results of ANSWER-HF Randomized Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.10.053","source_url":"https://doi.org/10.1016/j.jacc.2025.10.053","authors":["Vagner Madrini","Paulo Vinicius Ramos Souza","Fabio Fernandes","Barbara Maria Ianni","Alan Silva Martins","Georgina Jadán Luzuriaga","Keila Cardoso Barbosa Fonseca","Orlando do Nascimento Ribeiro","Allecineia Bispo da Cruz","Rosimeiri Oliveira","Talita Leopoldino Antunes","Fernanda Gallinaro Pessoa","Lucas Petri Damiani","Laura Sbeghen Quaglio","Vinicius Machado Correia","Murillo Oliveira Antunes","Charles Mady","Patrícia O Guimarães","Caio A M Tavares","Bruno Biselli","Cesar José Gruppi","Wilson Mathias","David Costa de Souza Le Bihan","Edimar Alcides Bocchi","Renato D Lopes","Felix José Alvarez Ramires"],"significance":7,"published":"2026-03-17","source_date":"2026-03-17","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"The ANSWER-HF primary results confirmed that sacubitril-valsartan reduces NT-proBNP more than enalapril in Chagas cardiomyopathy, the first ARNI evidence specific to this Latin American heart failure etiology.","created":"2026-07-03T10:32:13Z","updated":"2026-07-03T13:31:11Z","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":"Primaire resultaten van ANSWER-HF bevestigden dat sacubitril/valsartan bij Chagas-hartfalen het NT-proBNP sterker verlaagt dan enalapril. ARNI is effectief bij deze unieke HF-etiologie.","abstract_original":"BACKGROUND: Chronic Chagas cardiomyopathy (CCC) represents a common cause of nonischemic heart failure with reduced ejection fraction (HFrEF) in Latin America, yet evidence from randomized trials remains scarce. Sacubitril-valsartan has shown benefits in HFrEF of other etiologies, but less is known about its effects on CCC. OBJECTIVES: The authors sought to compare the effects of sacubitril-valsartan vs enalapril on cardiac remodeling, functional outcomes, biomarkers, and safety in patients with CCC and HFrEF. METHODS: ANSWER-HF was a randomized, double-blind, controlled trial in Brazil. A total of 190 patients with CCC and HFrEF (left ventricular ejection fraction [LVEF] <40%, NYHA functional class II-IV) were randomized in a 1:1 ratio to sacubitril-valsartan or enalapril and followed for 6 months. The primary endpoint was change in LVEF from baseline to 6 months. The win ratio method analyzed the hierarchical secondary endpoint of cardiovascular death, heart failure hospitalization, N-terminal pro-B-type natriuretic (NT-proBNP) change, and LVEF change. RESULTS: Mean age was 61 years, 40% women, and 69% Black or mixed race. Baseline mean LVEF was 30.1%. At 6 months, mean LVEF increased by 2.1% with sacubitril-valsartan and 1.2% with enalapril (between-group difference 0.9 percentage points; 95% CI: -0.9 to 2.6; P = 0.36). In hierarchical analysis, sacubitril-valsartan achieved more wins than enalapril (win ratio 1.80; 95% CI: 1.27-2.63). Median NT-proBNP was significantly lower with sacubitril-valsartan (geometric mean ratio 0.68; 95% CI: 0.57-0.81; P < 0.001). No significant differences were observed in echocardiographic remodeling or 6-minute walk distance, and the occurrence of safety outcomes were comparable. CONCLUSIONS: In patients with CCC and HFrEF, sacubitril-valsartan did not result in significant improvements in LVEF compared with enalapril after 6 months, but was associated with a greater reduction in NT-proBNP. No safety concerns were associated with either the sacubitril-valsartan or enalapril group. These findings establish the feasibility and safety of conducting trials in this neglected disease, demonstrate biological activity of sacubitril-valsartan and enalapril in HFrEF due to CCC, and chart the path for larger, outcome-driven studies. The ANSWER-HF represents an important step forward, beginning a new era of evidence generation for Chagas cardiomyopathy. (Angiotensin Receptor-Neprilysin Inhibition in Chagas Cardiomyopathy With Reduced Ejection Fraction [ANSWER-HF]; NCT04853758)."}