PARACHUTE-HF: First Randomized Trial in Chagas Cardiomyopathy Shows Benefit of Sacubitril-Valsartan

During ESC® 2025, Dr. Michael Gibson interviewed Dr. Renato Lopes about the PARACHUTE-HF trial, the first robust randomized clinical trial dedicated to Chagas cardiomyopathy. Lopes emphasized that Chagas disease, once confined to Latin America, now affects an estimated 7 to 8 million people worldwide, including approximately 400,000 in non-endemic regions such as the United States and Europe.

The study enrolled 922 patients with HFrEF and confirmed Chagas disease, randomized to receive either sacubitril/valsartan or enalapril. The hierarchical primary endpoint, assessed using the Win Ratio method, included cardiovascular mortality, heart failure hospitalization, and change in NT-proBNP at 12 weeks. Results were positive, with a win ratio of 1.52 in favor of sacubitril/valsartan, mainly driven by a 32% reduction in NT-proBNP, in addition to trends toward reduced cardiovascular death and heart failure hospitalization, although these individual outcomes did not reach statistical significance.