Sacubitril/Valsartan Versus Enalapril in Chagas Cardiomyopathy With Heart Failure: A Systematic Review and Meta-Analysis

Chagas cardiomyopathy represents a distinct and understudied etiology of heart failure with reduced ejection fraction (HFrEF). This meta-analysis aims to compare the efficacy and safety of sacubitril/valsartan versus enalapril in the treatment of patients with HFrEF due to Chagas cardiomyopathy with a total of 1225 patients (615 in the sacubitril/valsartan group and 610 in the enalapril group). There were no statistically significant differences between sacubitril/valsartan and enalapril in hospitalization for heart failure [risk ratios (RR) = 0.93; 95% confidence intervals (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 all efficacy outcomes (I2 = 0-4.1%). Similarly, we found no significant differences in safety outcomes, including symptomatic hypotension (RR = 1.14; 95% CI, 0.94-1.39), kidney dysfunction (RR = 1.08; 95% CI, 0.84-1.39), or hyperkalemia (RR = 1.26; 95% CI, 0.37-4.32). Our results indicated that sacubitril/valsartan has comparable efficacy to enalapril with no significant differences in hospitalization for heart failure, cardiovascular mortality, or all-cause mortality in patients with HFrEF secondary to Chagas cardiomyopathy.