The evaluation of peak atrial longitudinal strain (PALS) by Speckle-tracking echocardiography is also useful as an index of LV filling pressures and diastolic function: this parameter was also tested in AHF patients and it was demonstrated that in this context, associated with N-terminal pro B-type natriuretic peptide (NT-proBNP), it may be used as an additional index of congestion to optimize therapeutic management and could enhance the prognostic stratification of HF [33] (Table 1). This evidence concerns the gene NPPB and hydrops fetalis.