Selected Potential Causes of Elevated Natriuretic Peptide Levels38 41 Cardiac HF, including RV syndromes Acute coronary syndromes Heart muscle disease, including LVH Valvular heart disease Pericardial disease Atrial fibrillation Myocarditis Cardiac surgery Cardioversion Toxic-metabolic myocardial insults, including cancer chemotherapy Noncardiac Advancing age Anemia Renal failure Pulmonary: obstructive sleep apnea, severe pneumonia Pulmonary hypertension Critical illness Bacterial sepsis Severe burns Modified from Table 8 of the 2013 HF guideline.9 HF, indicates heart failure; LVH, left ventricular hypertrophy; and RV, right ventricular. Yancy et al Because of the absence of clear and consistent evi- dence for improvement in mortality and cardiovascular there are insufficient data to inform spe- cific guideline recommendations related to natriuretic peptide guided therapy or serial measurements of BNP or NT-proBNP levels for the purpose of reducing hospi- talization or deaths in the present document. Like natriuretic peptides, cardiac troponin levels may be elevated in the setting of chronic or acute decom- pensated HF, suggesting myocyte injury or necrosis.63 Troponins I and T respond similarly for acute coronary syndromes and acute decompensated HF. 