Large randomised, controlled studies have found that modulating dysregulated neurohormonal systems in patients with heart failure can reduce morbidity and mortality in those with a reduced left ventricular ejection fraction (LVEF).1 However, long term clinical outcomes remain poor, and most patients are unable to achieve the target doses of guideline-directed therapy. Further, these drugs do not resolve all the pathophysiological perturbations associated with heart failure. Interest in biomarker discovery is therefore growing, not only to facilitate earlier diagnosis and risk stratification, but also to identify novel targets for therapeutic interventions.