Cardiac damage can manifest itself by morphologic changes (e.g. LV hypertrophy), diastolic dysfunction, atrial fibrillation, elevated biomarkers (N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), B-type natriuretic peptide (BNP), troponin), mitral regurgitation, dilated left atrium and eventually also right heart changes that include tricuspid regurgitation and right ventricular dilation and dysfunction.40, 41, 42 In a large registry of 1931 patients with moderate AS, LV geometry was normal in only one-fifth.40 Here, NPPB is linked to mitral valve insufficiency.