NPPA and heart failure: Cardiac remodeling occurs after volume overload, high pressure, or ischemic injury during the development of heart failure.2 Cardiac hypertrophy and fibrosis, 2 essential changes in cardiac remodeling, are key to the initiation and progression of some cardiovascular diseases.3 Myocardial hypertrophy features rising heart weight and the activation of genes including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP).4,5 Cardiac hypertrophy usually results in fibrosis, which is manifested by collagen type I and collagen type III accumulation.6