Innovations in heart failure management: The role of cutting-edge biomarkers and multi-omics integration

Abstract

Heart failure (HF) remains a major cause of morbidity and mortality worldwide and represents a major challenge for diagnosis, prognosis and treatment due to its heterogeneity. Traditional biomarkers such as BNP and NT-proBNP are valuable but insufficient to capture the complexity of HF, especially phenotypes such as HF with preserved ejection fraction (HFpEF). Recent advances in multi-omics technology and novel biomarkers such as cell-free DNA (cfDNA), microRNAs (miRNAs), ST2 and galectin-3 offer transformative potential for HF management. This review explores the integration of these innovative biomarkers into clinical practice and highlights their benefits, such as improved diagnostic accuracy, enhanced risk stratification and non-invasive monitoring capabilities. By leveraging multi-omics approaches, including lipidomics and metabolomics, clinicians can uncover new pathways, refine the classification of HF phenotypes, and develop personalized therapeutic strategies tailored to individual patient profiles. Remarkable advances in proteomics and metabolomics have identified biomarkers associated with key HF mechanisms such as mitochondrial dysfunction, inflammation and fibrosis, paving the way for targeted therapies and early interventions. Despite the promising results, significant challenges remain in translating these findings into routine care, including high costs, technical limitations and the need for large-scale validation studies. This report argues for an integrative, multi-omics-based model to overcome these obstacles and emphasizes the importance of collaboration between researchers, clinicians and policy makers. By linking innovative science with practical applications, multi-omics approaches have the potential to redefine HF management and lead to better patient outcomes and more sustainable healthcare systems. • Emerging biomarkers for HF management: Integration of classical (e.g. BNP, NT-proBNP) and novel biomarkers (e.g. galectin-3, ST2, cfDNA) improves diagnostic and prognostic accuracy in heart failure (HF) and closes gaps in stratification of HF phenotypes (HFrEF and HFpEF). • Pathophysiological insights: Multi-omics approaches reveal underlying mechanisms of HF progression, such as oxidative stress, inflammation and mechanical overload, leading to targeted biomarker identification. • Clinical applications: Biomarkers provide critical insights for HF diagnosis, risk stratification and therapy monitoring, facilitating early intervention and personalized care. • Challenges in multi-omics integration: overcoming the technical, financial and ethical challenges is critical to the widespread adoption of multi-omics in HF management, especially in resource-constrained settings. • Future Directions: The focus is on developing HF-specific workflows, scalable technologies and collaborative frameworks to bridge the gap between research findings and clinical implementation.

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