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Prognostic value of CT-IGFBP-4 for all-cause mortality was evaluated in emergency patients with acute heart failure (HF). CT-IGFBP-4 independently predicted all-cause mortality in patients with acute HF at one month and one year follow-up. The ability of CT-IGFBP-4 to predict mortality in patients with acute heart failure suggests that PAPP-A/IGFBP-4 can be involved in the pathogenesis of HF.