In particular, the addition of the combination of key metabolites to established risk factors significantly increased the predictive performance for HF risk: hs-cTnT AUC: 0.82, 95% CI 0.74–0.88, hs-cTnT and Metabolites AUC: 0.89, 95% CI 0.84–0.94, NT-proBNP AUC: 0.88, 95% CI 0.83–0.93, NT-proBNP and Metabolites AUC: 0.94, 95% CI 0.91–0.97. Here, NPPB is linked to hydrops fetalis.