The role of microRNAs in acute and chronic heart failure: a key regulator and therapeutic target

Heart Failure (HF) represents the terminal stage of various cardiac diseases and is classified into Acute Heart Failure (AHF) and Chronic Heart Failure (CHF) based on the onset speed. Both are characterized by impaired myocardial function, neurohumoral disturbance, and ventricular remodeling, yet exhibit significant differences in pathophysiological mechanisms and clinical phenotypes. MicroRNAs (miRNAs), a class of non-coding RNAs approximately 18-25 nucleotides in length, regulate gene expression at the post-transcriptional level by targeting the 3' untranslated region (3'UTR) of target gene messenger RNAs. They are extensively involved in physiological and pathological processes such as cell proliferation, apoptosis, and fibrosis. A growing body of evidence has confirmed that abnormal miRNA expression profiles are closely associated with the occurrence and progression of HF, playing a crucial regulatory role in the pathological processes of both AHF and CHF. This review systematically examines the biological characteristics of miRNAs and elaborates on their core regulatory roles in the pathophysiological mechanisms of AHF and CHF. It analyzes differences and commonalities in miRNA expression and function between the two conditions, and explores the clinical application prospects of miRNAs as diagnostic markers, prognostic indicators, and therapeutic targets for HF. Finally, it summarizes current research challenges and future directions, aiming to provide a theoretical basis for the precise diagnosis and treatment of HF.