Background: Circulating adiponectin concentration increases in patients with chronic heart failure (HF).We sought to explore the prognostic value of temporal changes in adiponectin concentration following treatment for chronic HF. Methods: Serum adiponectin levels were measured at baseline and after a 3-month anti-failure treatment in 124 patients with symptomatic chronic systolic HF. Major adverse cardiac events (MACE) including death, heart transplantation, or hospitalization with worsening HF during a median follow-up period of 752 days were determined. Results: Univariate and multivariate analysis showed that high levels of adiponectin after a 3-month treatment were associated with a 3.8-fold increased risk of MACE (p = 0.03), independent of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Moreover, the combining of circulating levels of adiponectin with NTproBNP provided independent and additional prognostic value in identifying high risk patients with MACE during follow-up. Conclusions: Changes in adiponectin and NT-proBNP over time provide prognostic information.When adiponectin is used in conjunction with NT-proBNP in chronic HF, the prognostic value may be better than if each biomarker is used separately.