Most studies on medical therapies for failing sRV show limited benefits of traditional HF medication: a meta-analysis found no significant effects of angiotensin-converting enzyme inhibitors, angiotensin receptor neprilysin inhibitor, beta-blockers, and mineralcorticosteroids receptor antagonists on CMR dimensions and functions, or CPET results, nor did they reduce HF risk or mortality.20 This evidence concerns the gene ACE and hydrops fetalis.