ACLY and hydrops fetalis: Reduced ACLY expression in human HF may contribute to altered mitochondrial respiratory function and NAD+/NADH imbalance, and our findings add another molecular target for NAD+ supplementation therapy to treat HF conditions.PerspectivesCOMPETENCY IN MEDICAL KNOWLEDGE: HF has been traditionally viewed and treated from the perspectives of hemodynamic, neurohormonal, and structural abnormalities.