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In sufferers with coronary heart failure (HF) brought on by Chagas illness, sacubitril/valsartan was superior to enalapril for the composite major endpoint, predominantly pushed by a big discount in N-terminal pro-B-type natriuretic peptide (NT-proBNP), based on late-breaking analysis offered in a Scorching Line session at the moment at ESC Congress 2025.
Chagas illness, brought on by Trypanosoma cruzi an infection, stays a severe well being drawback affecting greater than 7 million folks, primarily from Latin America. T. cruzi parasites are primarily transmitted by contact with feces/urine of contaminated triatomine bugs. T. cruzi will also be transmitted by consumption of contaminated meals/drinks, throughout being pregnant or start, by blood/blood merchandise, organ transplantation and laboratory accidents.
Chagas illness is spreading world wide, predominantly resulting from migration of contaminated sufferers to different areas, together with North America, Europe, Asia and Australia. Chagas cardiomyopathy is taken into account the commonest and severe manifestation of persistent Chagas illness, occurring in 30–40% of contaminated folks throughout long-term follow-up.
“HF caused by Chagas disease has unique clinical features with worse prognosis than other causes of HF despite the fact that patients are often younger and have fewer comorbidities,” defined Professor Renato Lopes from Duke College Medical Middle, Durham, U.S., Principal Investigator of the PARACHUTE-HF trial.
“There have been no prospective randomized trials testing the effects of standard treatments in patients with Chagas disease and HF. In the general HF population, the angiotensin receptor–neprilysin inhibitor, sacubitril/valsartan improved HF outcomes vs. the angiotensin-converting enzyme inhibitor, enalapril, and we compared these two agents in the largest trial in patients with Chagas disease and HF conducted to date.”
PARACHUTE-HF was an academic-led, open-label, blinded-endpoint adjudication, randomized trial performed at greater than 80 websites in Brazil, Argentina, Mexico and Colombia. Eligibility standards included a prognosis of Chagas illness confirmed by not less than two totally different serological exams optimistic for Trypanosoma cruzi an infection, left ventricular ejection fraction (LVEF) ≤40%, New York Coronary heart Affiliation purposeful class II to IV signs and NT-proBNP ≥600 pg/ml or ≥400 pg/ml and hospitalization for HF throughout the final 12 months.
Individuals had been randomized 1:1 to both sacubitril/valsartan (50 or 100 mg twice each day titrated to a goal of 200 mg twice each day) or enalapril (2.5 or 5 mg twice each day titrated to a goal of 10 mg twice each day). The first endpoint was a hierarchical composite consequence consisting of cardiovascular demise, first hospitalization for HF and the relative change from baseline to week 12 in NT-proBNP, analyzed utilizing a win ratio method.
In whole, 922 sufferers had been randomized. The imply age was 64 years, 42.0% had been ladies, imply LVEF was 29.8% and 44.4% had had prior hospitalization for HF.
The numerous distinction within the major consequence was predominantly pushed by the p.c change in NT-proBNP from baseline to 12 weeks: logarithmic median change from baseline was −30.6% in these assigned to sacubitril-valsartan and −5.5% in these assigned to enalapril (ratio of adjusted geometric imply change 0.68; 95% CI 0.62 to 0.75).
The security profiles of the 2 brokers had been related, with discontinuations resulting from antagonistic occasions occurring in 6.1% of sufferers with sacubitril/valsartan and 9.8% with enalapril.
Concluding, Professor Lopes mentioned, “In sufferers with HF brought on by Chagas illness, sacubitril/valsartan was superior to enalapril with respect to the first consequence, predominantly pushed by the 32% discount in NT-proBNP ranges at week 12. Our examine gives the primary randomized trial proof to assist a pharmacological remedy particularly on this high-risk inhabitants.
“PARACHUTE-HF shows that much-needed studies to better characterize chronic Chagas cardiomyopathy and to define the benefit/risk of new therapies in this condition are possible. In line with the global health spotlight of ESC Congress, the PARACHUTE-HF trial provides a successful model for international collaborations—in this field among cardiologists and infectious disease physicians − with the shared goal of evaluating the impact of new therapies on cardiovascular outcomes in patients with neglected diseases.”
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Optimistic outcomes revealed from first potential trial in coronary heart failure resulting from Chagas illness (2025, September 1)
retrieved 1 September 2025
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