In the past decades, although numerous biomarkers, such as BNP, NT-proBNP, cardiac troponin T/I, interleukin family member ST2 and galectin-3, have emerged that might aid in the complex decision-making processes for diagnosis, evaluation and treatment of HF 8,28, multimarker strategy might be warranted in future because an ideal biomarker is required to have high specificity, sensitivity and reproducibility, little biovariability, and independence of demographical characteristics 29. This evidence concerns the gene NPPB and hydrops fetalis.