Although treatment of heart failure by positive inotropic drugs, such as β-adrenoreceptor agonists or PDE inhibitors, increased long-term mortality (Packer et al, 1991; O’Connor et al, 1999; Toma & Starling, 2010), directly targeting SERCA2a by overexpression gene therapy (Jessup et al, 2011) or by the small molecule activator istaroxime demonstrated absence of severe side-effects in patients with heart failure (Carubelli et al, 2020). This evidence concerns the gene ALDH7A1 and heart failure.