Assenza’s observation that a fragmented and prolonged QRS complex (the ECG equivalent of dyssynchrony) identifies patients with a more severe EA including more pronounced functional impairment and worse clinical profile [26], is keeping in with our findings relating dyssynchrony from imaging (C-SDI, 4D–SDI, CURE), heart failure markers (BNP, NYHA class) and severity of EA (R/L-Index). Here, NPPB is linked to heart failure.