Chagas cardiomyopathy represents an underrepresented cause of heart failure with reduced ejection fraction (HFrEF), with limited comparative evidence for guideline-directed therapies. In a meta-analysis published in Cardiology in Review, the efficacy and safety of sacubitril/valsartan were compared with enalapril in patients with HFrEF secondary to Chagas cardiomyopathy.

The analysis included 1225 patients, with 615 receiving sacubitril/valsartan and 610 receiving enalapril. Outcomes assessed included hospitalization for heart failure, cardiovascular mortality, and all-cause mortality, along with safety endpoints such as symptomatic hypotension, kidney dysfunction, and hyperkalemia. Risk ratios (RR) with 95% confidence intervals (CI) were calculated, and heterogeneity was assessed.

No statistically significant differences were observed between sacubitril/valsartan and enalapril for hospitalization for heart failure (RR=0.93; 95% CI: 0.74-1.16; p=0.53), cardiovascular mortality (RR=0.91; 95% CI: 0.73-1.12; p=0.37), or all-cause mortality (RR=0.96; 95% CI: 0.79-1.17; p=0.69). Heterogeneity was low across outcomes (I²=0–4.1%). Safety outcomes were also similar between groups, including symptomatic hypotension (RR=1.14; 95% CI: 0.94-1.39), kidney dysfunction (RR=1.08; 95% CI: 0.84-1.39), and hyperkalemia (RR=1.26; 95% CI: 0.37-4.32).

These findings indicate comparable efficacy and safety between sacubitril/valsartan and enalapril in patients with Chagas cardiomyopathy-related HFrEF.