A pivotal Brazilian trial has provided new insight into the treatment of Chagas cardiomyopathy, one of Latin America’s most neglected causes of HF. The ANSWER-HF study, published in the Journal of the American College of Cardiology, compared sacubitril valsartan with enalapril in patients with chronic Chagas cardiomyopathy and HFrEF.

The randomized, double-blind trial included 190 adults with a LVEF below 40% and New York Heart Association class II to IV symptoms. After six months, the mean ejection fraction increased by 2.1% with sacubitril valsartan and by 1.2% with enalapril. Although the difference was not statistically significant, NT-proBNP levels fell significantly more with sacubitril valsartan (geometric mean ratio 0.68; P < 0.001).

No differences were observed in safety outcomes, echocardiographic remodeling, or six-minute walk distance. These findings confirm that sacubitril valsartan is safe and biologically active in Chagas-related HF and highlight the feasibility of conducting large-scale trials in this underserved population.