Although this is perhaps counterintuitive given the overwhelming evidence of benefit of SGLT2 inhibitors in HF, this has actually also been reported in other trials including patients with chronic26 and acute HF.27 In both of these studies, SGLT2 inhibition led to a clinically important benefit despite the absence of a change in natriuretic peptide levels. Here, SLC5A2 is linked to hydrops fetalis.