Biomarkers have established an important role in the diagnosis and prognosis of heart failure in adults and may represent an objective tool to confirm functional status and echocardiographic indices of left ventricular dysfunction in children with HF.

The use of serial BNP or NT-proBNP measurements in children to guide therapeutic intervention or to monitor HF status shows some promise. High-sensitivity C reactive protein, cytokines, cytokine receptors, cardiac troponins and gene expression profiling are all emerging as a useful assessment tools in adults and further study is required to validate the role of these measures in children with HF.

BNP/ NT-proBNP could rule-in or support of initial working diagnosis of HF. BNP is active and has vasodilators effect and its metabolite (Nt-proBNP) inactive. Both increases the levels in acute myocardial dysfunction, declines with treatment or recovery from disease and could rule out respiratory problems instead of HF worsening. Normal levels are BNP < 100 pg/ml and Nt-proBNP < 300 pg/ml. Levels of BNP > 300 pg/ml or Nt-proBNP > 900 pg/ml are the cut-off points for decompensated cases, with a sensitivity and specificity > 85%. The importance in biomarkers clinical use is the trend, more than an isolated measure.

Other biomarkers in HF uses in research and still not clinical applications worlwide:

• ST2 a protein member of the IL-1 receptor family, reflects cardiovascular stress and fibrosis. Currently American College of cardiology Foundation/ American Heart Association Class II recommendation if than ST2 assay is a valuable tool for risk stratification in the setting
• Galectine 3 is secreted by activated macrhophages and causes cardiac fibrosis by proliferation of cardiac fibroblasts. It could be a marker of cardiac remodelling and has strong prognosis value, more than for diagnosis of HF. PRIDE-study in patients adults with HF, high galectine-3 concentrations showed predictive of 60-day mortality. Currently American College of cardiology Foundation/ American Heart Association Class II for risk prediction in HF.