Is It the Time to Revolutionize the Heart Failure Management with Emerging Biomarkers and Innovative Targeted Treatments? From Re-Search Evidence to Clinic

Biomarkers are now considered valuable adjunctive tests for the diagnosis, prognosis and management of heart failure (HF). Natriuretic peptides have considerably improved the assessment and management of HF patients, but they have several limitations. Given the complex HF pathophysiology, no single biomarker can adequately address the diagnosis, prognosis and outcomes. Therefore, the use of multiple biomarkers can improve HF management, applying a multifaceted pathophysiological approach. An exponential number of emerging biomarkers is reported in the literature, many of which have been shown to be independent HF risk factors, and, more significantly, when combined. They are also increasingly being used as targets in the development of innovative treatments, such as targeted and personalized therapies, also thanks to the application of artificial in-telligence models and use of multi-omics approaches. In this review, we have provided extensive evidence that highlights the need to revolutionize both HF management and therapies. A detailed overview of emerging biomarkers, potential targets and therapies is here reported, illustrating their advantages and limitations, as well as possible solutions to overcome them, and highlighting their strong promising potential. This could allow us to predict this disease in the general population, to perform an early diagnosis, limiting complications and mortality. The road to its realization is arduous, but feasible, and it will require further efforts by researchers and clinicians with different multidisciplinary skills.