The objectives of this study were to: 1) Determine whether incorporating galectin-3 and periostin with NT-proBNP improves classification of cardiac dysfunction by cardiac strain compared to NT-proBNP, alone; and 2) Compare mortality risk stratification of patients with SSc by a multi-biomarker approach using periostin, galectin-3, and NT-proBNP versus NT-proBNP, alone. The gene discussed is NPPB; the disease is systemic sclerosis.