ISSN 2996-8215
International Journal of Cardiology | Vol. 11, No. 12, December 2020 | pp. 89–96
DOI: 10.46882/2020/IJC/000141
Original Research Article
Prognostic Value of Circulating MicroRNA-21 in Patients Hospitalized with Acute Decompensated Heart Failure
Stefan de Vries¹, Anika Janssen¹, Jan de Jong²
¹Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
²Division of Cardiovascular Medicine, Leiden University Medical Center, Leiden, Netherlands
Abstract:
Acute decompensated heart failure (ADHF) requires precise risk stratification to guide clinical transitions and prevent early rehospitalizations. MicroRNAs (miRNAs) are stable circulating biomolecules actively involved in cardiovascular remodeling. This study evaluated the long-term prognostic value of plasma miR-21 expression levels in a prospective cohort of patients hospitalized for ADHF. We enrolled 210 patients presenting with a primary admission diagnosis of ADHF. Blood samples were obtained within 24 hours of hospital admission, and plasma miR-21 expression levels were quantified using real-time quantitative polymerase chain reaction. The primary endpoint was a composite of 12-month all-cause mortality or heart failure readmission. High plasma miR-21 expression (above the cohort median) was identified in 50.0% of the study population. At 12 months, the primary composite endpoint occurred in 64 patients (30.5%). Survival analysis demonstrated a significantly lower event-free survival rate in the high miR-21 cohort compared to the low expression group (42.2% vs. 18.8%, log-rank p < 0.001). After adjusting for age, left ventricular ejection fraction, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP), multivariable Cox proportional hazards regression confirmed that elevated baseline miR-21 expression was an independent predictor of the composite outcome (hazard ratio: 2.15, 95% CI: 1.34–3.46, p = 0.001). Elevated plasma microRNA-21 levels at admission independently predict poor 12-month survival and readmission rates in acute decompensated heart failure, serving as a promising molecular biomarker for refined risk stratification.
Keywords: Acute decompensated heart failure, MicroRNA-21, Biomarkers, Prognosis, Mortality, Heart failure readmission
Received: September 12, 2020; Revised: October 25, 2020; Accepted: November 10, 2020; Published: December 19, 2020