NPPA and Myocardial fibrosis: Thus, the observed hemodynamic changes and cardiac adaptions neither led to any impairment of systolic function, nor to myocardial injury or myocardial fibrosis and these observations are in line with those of Busk et al. who also found a preserved LVEF and TAPSE as well as stable values for proANP and hs-TnT four months after TIPS15.