While BNP and NT-proBNP are widely regarded as the gold standard in prognostic diagnosis and stratification of HF, their sensitivity in the diagnosis of acute HF and Heart failure with preserved ejection fraction (HFpEF) may be low [32, 33], and their accuracy is influenced by various factors, including age, sex, ethnicity, genetic variants, and numerous cardiac and non-cardiac conditions [34]. This evidence concerns the gene NPPB and hydrops fetalis.