NPPA and heart failure: In terms of mechanisms, trimetazidine has been shown to reduce the expression of atrial natriuretic peptide (ANP) (Morgan et al., 2006), increase left ventricular high-energy phosphate levels (Fragasso et al., 2006b), and reduce the risk of arrhythmias in heart failure (Gunes et al., 2009b; Cera et al., 2010).