Weaker associations were seen in those without raised NT-pro-BNP [HR = 1.23 (0.66-2.27)].<h4>Conclusion</h4>Elevated KB ratio is associated with a significantly increased risk of HF and may serve as a biomarker of HF incidence particularly when NT-pro-BNP is also elevated. This evidence concerns the gene NPPB and hydrops fetalis.