NPPA and myocardial ischemia: Similarly, individuals with IHD had decreased heart contractility mirrored in reduced left ventricular ejection fraction (LVEF) and increased plasma pro-atrial natriuretic peptide (pro-ANP) levels relative to both HCs and MMCs (P < 0.001), which was further altered in the HF subgroup relative to ACS and CIHD (P < 0.001) (Extended Data Fig. 1 and Supplementary Table 2).