ARNI Over ACEI Lacks Clinical Benefit in Patients With Chagas Cardiomyopathy

Chagas cardiomyopathy is the most common presentation of the determinate form of Trypanosoma cruzi infection and carries a worse prognosis than other common causes of heart failure. The 3 most common causes of death from Chagas cardiomyopathy are sudden cardiac death due to malignant ventricular arrhythmias, progression of heart failure, and, less frequently, thromboembolic events. Although traditionally a neglected disease in Latin America, the impact of Chagas cardiomyopathy is no longer confined to historically endemic areas, owing to population migration and northward expansion of the vector habitats. Chagas cardiomyopathy is endemic in the US, with autochthonous transmission (ie, transmission originating within the local environment) reported in at least 8 southern US states. Over the past 2 decades, there has been a growing recognition of Chagas cardiomyopathy, with dedicated clinical research uncovering key disease-specific insights. Potential preventive and therapeutic strategies include traditional infectious disease approaches aimed at parasite eradication as well as interventions directed at the cardiac manifestation of disease, such as reducing and treating arrhythmic burden and optimizing guideline-directed medical therapy.