Given its strong association with neurohormonal activation and myocardial remodeling, ET-1 could be integrated into a multimarker approach, combining biomarkers that capture different aspects of AHF pathophysiology, such as myocardial stress (NT-proBNP), fibrosis and inflammation (GDF-15), and endothelial dysfunction (ET-1). This evidence concerns the gene GDF15 and endothelial dysfunction.