As a result, it backs up the evidence that DAPA and EMPA had no effect on NT-proBNP. Thus, the contrasting effects of SGLT-2i in DAPA-HF from DEFINE-HF are explained by the mechanism of diuretic effect due to an increase in hematocrit or reduction of afterload due to decreased systolic pressure which together decreases the release of NT-proBNP [37]. Here, NPPB is linked to hydrops fetalis.