In patients presenting with acute dyspnea in pre-hospitalsetting, the early and correct diagnosis may present a significant clinical challenge.Physical examination, chest radiography, electrocardiography, and standard biological tests often fail to accurately differentiate heart failure (HF) from pulmonary causes of dyspnea).Timely differentiationof HF from other causes of dyspnea may permit the early institution of appropriate medical therapy).Brain natriuretic peptide (BNP) and amino-terminal pro-brain natriureticpeptide (NT-proBNP) have been proposed as earlymarkers of HF and demonstrated to be useful for diagnosingand excluding HF in emergency department.A combination of BNP or NT-proBNP testing and standard clinical assessment has been suggested to be superior to either tool used in isolation).