Like natriuretic peptides, cardiac troponin levels may be elevated in the setting of chronic or acute decom- pensated HF, suggesting myocyte injury or necrosis.63 Troponins I and T respond similarly for acute coronary syndromes and acute decompensated HF. Elevations in either troponin I or T levels in the setting of acute HF are of prognostic significance and must be interpreted in the clinical context.64 In addition to natriuretic peptides and troponins,65 67 multiple other biomarkers, including those of inflam- mation, oxidative stress, vascular dysfunction, and myo- cardial and matrix remodeling, have been implicated in Biomarkers of myocardial fibrosis, soluble ST2 receptor, and galectin-3 are predictive of hospitaliza- tion and death and may provide incremental prognos- tic value over natriuretic peptide levels in patients with Strategies that combine multiple biomarkers may ultimately prove beneficial in guiding HF therapy in the future, but multicenter studies with larger deri- vation and validation cohorts are needed.75,76 Several emerging biomarkers await validation with well-defined outcome measures and prognostic accuracy before they can reach the clinical arena.77 84 This section categorizes the role of biomarkers into prevention, diagnosis, prognosis, and added risk strati- fication to clarify evidence-based objectives of their use in clinical practice. 6.3.1 Biomarkers for Prevention: Recommendation Biomarkers: Recommendation for Prevention of HF COR LOE Recommendation Comment/Rationale IIa B-R For patients at risk of developing HF, natriuretic peptide biomarker based screening followed by team-based care, including a cardiovascular specialist optimizing GDMT, can be useful to prevent the development of left ventricular dysfunction (systolic or diastolic) or NEW: New data suggest that natriuretic peptide biomarker screening and early intervention may prevent HF. See Online Data Supplements A and B. 