Because of the lack of a high correlation between NYHA and LVEF, we attempted to assess the usefulness of the established and novel biomarkers of the biomechanical strain (NT-proBNP and sST-2) in predicting LVEF in patients with stable dilated cardiomyopathy presenting with mild and severe HF symptoms (NYHA I/II and III/IV). This evidence concerns the gene NPPB and hydrops fetalis.