NPPB and atrial fibrillation: As a matter of fact, natriuretic peptides reflect mainly severity of heart failure and not severity of valvular diseases and can be influence by other factors such as presence of other valvular diseases and atrial fibrillation, per se.28 Nevertheless, AVR decision in these patients should be based not only on severity of valvular disease but on overall cardiac remodelling, including assessment of Nt-proBNP ratio, valve lesion and general patient’s health.