Between haemodynamic and clinical pulmonary congestion (Fig. 2), an intermediate stage in the presymptomatic phase, detectable at lung auscultation or more often by lung ultrasound (US) (US-B lines) of chest X-ray Kerley B lines (Fig. 1) or an increase in levels of brain natriuretic peptide (BNP), which may act as indicators and intermediate endpoints of frank pulmonary oedema. This evidence concerns the gene NPPB and pulmonary vascular congestion.