Biomarkers (various laboratory biochemical markers), such as natriuretic peptides (NP), soluble ST2 receptor, copeptin, galectin-3, are widely studied in patients with chronic heart failure (CHF). The European Society of Cardiology recommends the determination of blood NP level in suspicion of HF and its use as one of the mandatory diagnostic criteria for CHF with preserved and mid-range ejection fraction. Dynamics of NP concentration may be predictor of the effectiveness of the therapy and the necessity of the titration of the dose of HF drugs. Neprilyzin destroys NP, but does not destroy their precursors, including NT-proBNP. Therefore, it is necessary to use NT-proBNP as a marker of therapeutic efficacy and prognosis when using neprilysine inhibitors (sacubitril). ST2 is a protein receptor for interleukin-33 (IL-33). The transmembrane ST2 (ST2L) binds to IL-33 and forms the IL-33/ST2L complex, which has a cardioprotective effect, prevents the development of myocardial hypertrophy, fibrosis and apoptosis. The soluble ST2 receptor (sST2) is a “trap” for IL-33 and neutralizes the protective effects of the IL-33/ST2L complex, which leads to hypertrophy and fibrosis of the myocardium, dilatation of the chambers and reduction of the contractility of the heart. It can be considered as a marker of unfavorable prognosis in heart failure, but it is not specific. Copeptin is a part of the arginine-vasopressin, or antidiuretic hormone, precursor which plays an important role in the pathogenesis of CHF. Since arginine-vasopressin has a short half-life and is unstable outside the body, copeptin is being actively investigated. Its level increases during the CHF decompensation and relates with the functional class of CHF. A combined measurement of the concentration of copeptin and NP may improve the risk stratification in CHF patients. Galectin-3 is a peptide that stimulates the activation of fibroblasts and the development of fibrosis. It increases in CHF patients and is associated with the severity of the condition, systolic and diastolic LV dysfunction and prognosis. Currently, NP are the best biomarkers that can and should be used in routine clinical practice. To prove the need for widespread use of other biomarkers, additional research is needed.

Inflammation plays a role in the pathogenesis of heart failure. Neopterin, pteridine, synthesized mainly by activated macrophages, is a marker of inflammation, activation of the immune system, and an active participant in cardiovascular disease. Measuring neopterin levels can help track the evolution of specific inflammatory conditions. In addition, neopterin was associated with cardiac dysfunction after cardiac surgery and improved the accuracy of predicting the risk of postoperative cardiac dysfunction. In this review, we provide current insights into neopterin and its relationship to heart failure.

Now there is a relevant development of the new biomarkers capable to serve as the instrument of early diagnostics of a disease for the purpose of selection of a pharmacotherapy and further monitoring of its efficiency. Galektin-3 is the atypical representative of the family of galektin. Its participation in fibrosis, remodeling of heart, the immunologic answer and inflammatory reactions are shown. Prognostic value is discussed and diagnostic opportunities of Galektin-3 at CHF are widely studied and take root into clinical practice. Now a great deal of research devoted to the studying of Galektin-3, possibilities of its use as a biomarker at diagnostics, forecasting of outcomes and the choice of therapeutic strategy at other cardiovascular diseases has been conducted.