The PIONEER-HF trial further supported the utility of sacubitril/valsartan in HFrEF by revealing that, among patients hospitalized for acute decompensated HF, sacubitril/valsartan led to a greater reduction in the N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration compared to enalapril therapy [7]. Here, NPPB is linked to hydrops fetalis.