Focus on earlier identification of heart failure risk

With the US population aging, prevalence of heart failure (HF) is projected to grow by 25% and associated direct costs by 215% by 2030.1

BNP and NT-proBNP: not just for diagnosis and management anymore

The natriuretic peptide (NP) biomarkers, B-type natriuretic peptide (BNP), and N-terminal pro B-type natriuretic peptide (NT-proBNP), which play a role in myocardial stress, have long served as clinically useful markers for heart failure diagnosis and management. New data and guidelines suggest that for patients at risk of developing HF, NP biomarker–based screening followed by team-based care, including a cardiovascular specialist optimizing guidelinedirected medical therapy, may be useful to prevent the development of new-onset HF.2 This means more people may benefit from BNP and NT-proBNP testing.

HF biomarker testing from Quest Diagnostics3

Biomarker Prevention Diagnosis Prognosis Therapy guidance
BNP ++++ ++++ ++++ ++
NT-proBNP ++++ ++++ ++++ ++
sST2   + ++++ N/A
Galectin-3     +++ N/A

Prevention: backed by clinical guidelines

The 2017 ACC/AHA updated Guidelines for the Management of Heart Failure recommend BNP or NT-proBNP testing for aiding in HF prevention. 2

Which patients warrant extra vigilance for heart failure risk?

Patients who may be at risk for developing heart failure include those with:

  • Poorly controlled hypertension
  • Diabetes
  • Known vascular disease

In addition, risk identification may serve as a wake-up call for patients of concern, e.g., those not adhering to medications or otherwise not following their treatment plan.

Enhance risk stratification

Once diagnosed with chronic heart failure, a patient may be tested for other markers to help identify whether they are at elevated risk of disease progression:

sST2 (ST2) is a soluble isoform of ST-2, an interleukin-1 receptor family member that is elevated in some inflammatory diseases, including HF. Patients with heart failure and elevated sST2 levels are at increased risk for heart failure progression, rehospitalization, heart transplantation, and death.4-5 ACCF/AHA guidelines recommend measurement of sST2 for additive risk stratification in patients with acute or chronic heart failure.7,8

Galectin-3 is a carbohydrate-binding lectin that increases collagen production and cardiac fibroblast proliferation. Elevated levels of galectin-3 have been associated with macrophage infiltration, cardiac fibrosis, and cardiac hypertrophy, which contribute to progression of heart failure and poor cardiovascular outcomes. Measuring galectin-3 in conjunction with BNP/NTproBNP and ST2 may further enhance risk stratification to monitor and treat HF and CVD.

Trust Quest Diagnostics for your cardiometabolic testing needs

From heart failure testing to diagnosis and monitoring, our test menu and related services can support you and your patients across the continuum of care.

Heart Failure biomarker testing from Quest

Test Name Clinical Use
B-Type Natriuretic Peptide (BNP)

Screen for heart failure risk
Diagnose heart failure
Help predict outcomes in patients with heart failure
Help guide pharmacologic treatment of
patients with heart failure


Screen for heart failure risk
Diagnose heart failure
Help predict outcomes in patients with
heart failure
Help guide pharmacologic treatment of
patients with heart failure

Cardio IQ® NT-proBNP

Screen for heart failure risk
Help determine risk of heart failure in patients with
stable coronary heart disease

Cardio IQ® ST2, Soluble

Help predict outcomes in patients with
heart failure

Cardio IQ® Galectin-3

Help identify individuals with chronic heart failure
at elevated risk of disease progression


This information is provided for informational purposes only and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.

Learn More

Download the BNP and NT-proBNP brochure
Download the Cardio IQ® NT-proBNP
Download the Cardio IQ® ST2, Soluble test summary
Download the Heart Failure Guidelines Summary Monograph
Review test information in our Test Directory


  1. Konstam MA. Home monitoring should be the central element in an effective program of heart failure disease management. Circulation. 2012;125:820-7.
  2. Yancy CW, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Circulation. 2017;CIR.0000000000000509. doi:
  3. Adapted from van Kimmenade RRJ and Januzzi JL. Emerging biomarkers in heart failure. Clin Chem. 2012;58(1):127-138.
  4. Ky B, French B, McCloskey K, et al. High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure. Circ Heart Fail. 2011;4:180-187.
  5. Ky B, French B, Levy WC, et al. Multiple biomarkers for risk prediction in chronic heart failure. Circ Heart Fail. 2012;5:183-190.
  6. Rehman SU, Mueller T, Januzzi JL Jr. Characteristics of the novel interleukin family biomarker ST2 in patients with acute heart failure. J Am Coll Cardiol. 2008;52:1458-1465.
  7. 2013 ACCF/AHA guideline for the management of heart failure. J Am Coll Cardiol. 2013:62(16);e147-e239.
  8. Bayes-Genis A, Zhang Y, Ky B. ST2 and patient prognosis in chronic heart failure. Am J Cardiol. 2015;115:64B-69B.