NPPB and systemic sclerosis: Furthermore, echocardiography is limited in detecting diastolic dysfunction [49], and widely established biomarkers including BNP as well as its prohormone, N-terminal-proBNP, may be also elevated in SSc-PH [50–52] and are frequently normal in HFpEF (heart failure with preserved ejection fraction, secondary to diastolic dysfunction) [53].