{"id":29747,"date":"2026-02-06T04:40:00","date_gmt":"2026-02-05T20:40:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29747"},"modified":"2026-02-06T05:45:37","modified_gmt":"2026-02-05T21:45:37","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-%e6%b2%99%e5%ba%93%e5%b7%b4%e6%9b%b2%e7%bc%ac%e6%b2%99%e5%9d%a6%e9%92%a0%ef%bc%88%e8%af%ba%e6%ac%a3%e5%a6%a5%ef%bc%89%e4%b8%8e%e4%be%9d%e9%82%a3%e6%99%ae","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29747","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]: \u6c99\u5e93\u5df4\u66f2\u7f2c\u6c99\u5766\u94a0\uff08\u8bfa\u6b23\u59a5\uff09\u4e0e\u4f9d\u90a3\u666e\u5229\u6cbb\u7597Chagas\u75c5\u5f15\u8d77\u7684\u5fc3\u529f\u80fd\u8870\u7aed"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Sacubitril\/Valsartan vs Enalapril in Heart Failure Due to Chagas Disease: An Open-Label, Multicenter Randomized Clinical Trial<\/h1>\n\n\n\n

Renato D. Lopes, Edimar Alcides Bocchi, Luis Eduardo Echeverr\u00eda, et al<\/h3>\n\n\n\n

JAMA Published Online: December 3, 2025<\/h3>\n\n\n\n

doi: 10.1001\/jama.2025.19808<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Are guideline-recommended treatments for heart failure (HF) effective and safe in patients with Chagas disease?<\/p>\n\n\n\n

Findings<\/strong>  This trial found that in patients with heart failure with reduced ejection fraction (HFrEF) due to Chagas cardiomyopathy, sacubitril\/valsartan was not significantly different from enalapril in the composite outcome of cardiovascular death or hospitalization for HF, but led to a greater reduction in N-terminal pro-B-type natriuretic peptide.<\/p>\n\n\n\n

Meaning<\/strong>  In patients with HFrEF due to Chagas disease, sacubitril\/valsartan did not result in better clinical outcomes.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>\u00a0\u00a0The efficacy and safety of guideline-recommended treatments for heart failure (HF) are uncertain in patients with Chagas disease.<\/p>\n\n\n\n

Objective<\/strong>  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.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  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] \u2265150 pg\/mL) or 400 pg\/mL or greater (or BNP \u2265100 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.<\/p>\n\n\n\n

Interventions<\/strong>  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.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  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.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Overall, 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% (\u221254.3% to \u22120.9%) at 12 weeks, leading to 22.5% wins, while those in the enalapril group had a 5.5% (\u221231.9% to 37.5%) decrease (7.2% wins). The resulting stratified win ratio was 1.52 (95% CI, 1.28-1.82;\u00a0P<\/em>\u2009<\u2009.001) for sacubitril\/valsartan compared with enalapril.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  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.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04023227<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Sacubitril\/Valsartan vs En […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29747"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29747"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29747\/revisions"}],"predecessor-version":[{"id":30116,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29747\/revisions\/30116"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29747"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29747"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29747"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}