Although an increased plasma NT-proBNP level is primarily used as a biomarker for left ventricular (LV) dysfunction26, it is not necessarily specific to heart failure and is influenced by various conditions that cause myocardial strain and affect the clearance of NT-proBNP, including myocardial ischemia, arrhythmia, sepsis, shock, anemia, renal failure, pulmonary embolism, asthma, acute respiratory disease syndrome, and chronic obstructive pulmonary disease32,36,39–42. This evidence concerns the gene NPPB and myocardial ischemia.