Positive results revealed from first prospective trial in heart failure due to Chagas disease

In patients with coronary heart failure (HF) precipitated by Chagas disease, sacubitril/valsartan was once superior to enalapril for the composite basic endpoint, predominantly driven by a important good deal in N-terminal pro-B-form natriuretic peptide (NT-proBNP), in line with gradual-breaking be taught presented in a Sizzling Line session this day at ESC Congress 2025.

Chagas disease, precipitated by Trypanosoma cruzi infection, stays a extreme neatly being distress affecting more than 7 million other folk, basically from Latin The United States. T. cruzi parasites are mainly transmitted by contact with feces/urine of infected triatomine bugs. T. cruzi can additionally be transmitted by consumption of wicked meals/beverages, at some stage in being pregnant or initiating, by blood/blood products, organ transplantation and laboratory accidents.

Chagas disease is spreading across the sphere, predominantly ensuing from migration of infected patients to other areas, along with North The United States, Europe, Asia and Australia. Chagas cardiomyopathy is regarded as basically the most in trend and extreme manifestation of power Chagas disease, occurring in 30–40% of infected other folk at some stage in long-duration of time apply-up.

“HF precipitated by Chagas disease has queer scientific facets with worse prognosis than other causes of HF even though patients are ceaselessly youthful and bear fewer comorbidities,” outlined Professor Renato Lopes from Duke University Scientific Heart, Durham, U.S., Significant Investigator of the PARACHUTE-HF trial.

“There bear been no prospective randomized trials attempting out the results of identical outdated treatments in patients with Chagas disease and HF. Within the total HF population, the angiotensin receptor–neprilysin inhibitor, sacubitril/valsartan improved HF outcomes vs. the angiotensin-changing enzyme inhibitor, enalapril, and we compared these two brokers in the excellent trial in patients with Chagas disease and HF performed to this level.”

PARACHUTE-HF was once an tutorial-led, delivery-mark, blinded-endpoint adjudication, randomized trial performed at more than 80 web sites in Brazil, Argentina, Mexico and Colombia. Eligibility criteria included a prognosis of Chagas disease confirmed by at the least two totally different serological assessments obvious for Trypanosoma cruzi infection, left ventricular ejection allotment (LVEF) ≤40%, Contemporary York Heart Association handy class II to IV signs and NT-proBNP ≥600 pg/ml or ≥400 pg/ml and hospitalization for HF all over the place in the final 12 months.

Contributors had been randomized 1:1 to both sacubitril/valsartan (50 or 100 mg twice daily titrated to a target of 200 mg twice daily) or enalapril (2.5 or 5 mg twice daily titrated to a target of 10 mg twice daily). The most important endpoint was once a hierarchical composite final result consisting of cardiovascular death, first hospitalization for HF and the relative switch from baseline to week 12 in NT-proBNP, analyzed utilizing a fetch ratio method.

In complete, 922 patients had been randomized. The point out age was once 64 years, 42.0% had been ladies folk, point out LVEF was once 29.8% and 44.4% had had prior hospitalization for HF.

Following pairwise comparisons, sacubitril/valsartan was once related to a 52% increased likelihood of a greater basic final result compared with enalapril (stratified unmatched fetch ratio 1.52; 95% self belief interval [CI] 1.28 to 1.82; p<0.001). Over a median of 25 months' apply-up, rates had been identical for sacubitril/valsartan vs. enalapril for cardiovascular death (hazard ratio [HR] 0.95; 95% CI 0.73 to 1.23) and first HF hospitalization (HR 0.92; 95% CI 0.70 to 1.20).

The plenty of contrast in basically the most important final result was once predominantly driven by the percent switch in NT-proBNP from baseline to 12 weeks: logarithmic median switch from baseline was once −30.6% in these assigned to sacubitril-valsartan and −5.5% in these assigned to enalapril (ratio of adjusted geometric point out switch 0.68; 95% CI 0.62 to 0.75).

The safety profiles of the 2 brokers had been identical, with discontinuations ensuing from negative events occurring in 6.1% of patients with sacubitril/valsartan and 9.8% with enalapril.

Concluding, Professor Lopes talked about, “In patients with HF precipitated by Chagas disease, sacubitril/valsartan was once superior to enalapril with respect to basically the most important final result, predominantly driven by the 32% good deal in NT-proBNP ranges at week 12. Our eye provides basically the most important randomized trial evidence to help a pharmacological medicine namely in this high-possibility population.

“PARACHUTE-HF displays that great-wished be taught to greater symbolize power Chagas cardiomyopathy and to stipulate the earnings/possibility of new therapies in this condition are that it is seemingly you’ll presumably perchance presumably presumably factor in. In accordance with the global neatly being spotlight of ESC Congress, the PARACHUTE-HF trial provides a a hit mannequin for global collaborations—in this field among cardiologists and infectious disease physicians − with the shared purpose of evaluating the affect of new therapies on cardiovascular outcomes in patients with overlooked diseases.”