In spring 2023, he presented with severe heart failure, pleural effusions, edema, renal failure, massive increase in NT-proBNP (22,743 ng/L, age-adjusted normal < 450 ng/L), a dilated LV with severely diminished LVEF of 20% and impaired LV GLS (Figure 3A). The gene discussed is NPPB; the disease is heart failure.