Therefore, glitazones might still be beneficial, especially when used in combination with SGLT2i to counteract fluid retention [157] The SAVOR-TIMI 53 trial demonstrated that the DPP-4 inhibitor saxagliptin increased the risk of HF hospitalisation [159], therefore raising concerns about the use of this drug class in patients HF or pre-existing LV dysfunction [160]. This evidence concerns the gene DPP4 and hydrops fetalis.