NPPB and hydrops fetalis: Moreover, the guideline stipulates that “the negative predictive values are very similar and high (94-98%) in both the nonacute and acute settings, but the positive predictive values are lower both in the nonacute setting (44-57%) and in the acute setting (66-67%).” To this point, the ESC's guidelines recommend that the diagnosis of HFpEF should be based on structural and Doppler findings of LVDD, and elevated NT-proBNP should be used to rule out HF [55].