Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC)

Eur J Heart Fail. 2021 Oct;23(10):1610-1632. doi: 10.1002/ejhf.2346. Epub 2021 Oct 10.


New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high-sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor-15 (GDF-15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic-based risk scores. We focused on guidance and assistance with daily clinical care decision-making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials.

Keywords: Adrenomedullin; Biomarkers; Cardiac troponin; Galectin-3; Growth differentiation factor-15; Heart failure; Procalcitonin; sST2.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Biomarkers
  • Cardiology*
  • Galectin 3
  • Heart Failure* / diagnosis
  • Humans
  • Natriuretic Peptides
  • Prognosis


  • Biomarkers
  • Galectin 3
  • Natriuretic Peptides