The proteins reflect neurohormonal activation, kidney dysfunction, ECM remodelling, myocardial stretch, and inflammation, all key pathways involved in the development and deterioration of HF.28 The strongest associations with elevated LAP were found for cystatin-D, EGF-containing fibulin-like ECM protein 1 (fibulin-3), and fibulin-5. Here, CST5 is linked to hydrops fetalis.