In the MESA study [37], cardiac MR-defined “malignant” LVH, which refers to the co-existence of LVH and elevated soluble cardiac biomarkers (such as troponin T for myocardial damage, NT-proBNP for myocardial hemodynamic stress) and LVH, may predict asymptomatic left ventricular dysfunction, the development of heart failure (particularly the HFrEF), and CV mortality in the general population. Here, NPPB is linked to heart failure.