Sacubitril/Valsartan vs Enalapril in Heart Failure Due to Chagas Disease
Rattachement africain : us, br, co, in, ca, ar, mx, es, ch, gb. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
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.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Sacubitril/Valsartan vs Enalapril in Heart Failure Due to Chagas Disease
- Date Crossref
- 06/01/2026
- Éditeur
- American Medical Association (AMA)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Clinical Research Institute pays non établi dans la noticeStructure de recherche
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Duke Institute for Health Innovation pays non établi dans la noticeInstitution
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Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Instituto do Coração (InCor) pays non établi dans la noticeÉtablissement de santé
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Fundación Cardiovascular de Colombia pays non établi dans la noticeÉtablissement de santé
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Novartis (India) pays non établi dans la noticeEntreprise
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University of Calgary Libin Cardiovascular Institute pays non établi dans la noticeUniversité ou école supérieure
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Libin Cardiovascular Institute of Alberta pays non établi dans la noticeStructure de recherche
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Hospital Donación Francisco Santojanni pays non établi dans la noticeÉtablissement de santé
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Instituto de Neurología Cognitiva pays non établi dans la noticeStructure de recherche
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Mexican Social Security Institute pays non établi dans la noticeOrganisme public
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Centro Medico Nacional Siglo XXI pays non établi dans la noticeÉtablissement de santé
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Instituto de Cardiologia do Distrito Federal pays non établi dans la noticeÉtablissement de santé
Clinical Research Institute, Duke Institute for Health Innovation et Instituto do Coração (InCor) — Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.