This further denotes several, different underlying pathophysiological pathways contribute to HF progression and suggests that GDF-15 as a marker of inflammation6 provides additional information compared with NT-proBNP, which reflects volume overload and myocardial stretch.23,24 To properly assess the incremental prognostic value of serially measured GDF-15 and more accurately predict HF risk, a multimarker approach with additional biomarkers is necessary. This evidence concerns the gene NPPB and hydrops fetalis.