ANSWER-HF: sacubitril-valsartan reduces NT-proBNP in heart failure due to Chagas cardiomyopathy despite no reverse remodeling.

Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure with reduced ejection fraction (HFrEF) in Latin America, yet robust evidence for optimal medical therapy remains scarce. This mini-review examines the results, strengths and limitations of the ANSWER-HF study, a single-center, double-blind randomized clinical trial comparing sacubitril–valsartan with enalapril in 190 patients with CCC-HFrEF over six months. The primary endpoint was change in left ventricular ejection fraction (LVEF). Secondary endpoints included N-terminal pro-B-type natriuretic peptides, echocardiography and functional parameters, clinical events and safety assessments. No significant differences were observed in LVEF, cardiac remodeling, 6-minute walk distance or clinical outcomes between study groups. However, patients randomized to sacubitril–valsartan achieved a significantly greater reduction in NT-proBNP at 6 months. These findings highlight the biological effect of sacubitril-valsartan in this population but reinforces the need for larger, long-term studies, powered to hard clinical endpoints, to further establish the role of sacubitril-valsartan in CCC.