The Role of MicroRNAs in the Pathophysiology and Management of Heart Failure: From Molecular Mechanisms to Clinical Application

Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, affecting over 30 million individuals, with its prevalence steadily increasing due to population aging. Among its forms, heart failure with preserved ejection fraction (HFpEF) has emerged as a major clinical and public health concern, now accounting for more than half of all HF cases and closely associated with comorbidities such as hypertension, obesity, and diabetes. MicroRNAs (miRNAs) have gained recognition as key regulators of the molecular mechanisms underlying HF, particularly HFpEF, where they modulate interconnected pathways of inflammation, fibrosis, and endothelial dysfunction. This review discusses the mechanisms by which miRNAs contribute to the pathogenesis of HF and examines their potential as both biomarkers and therapeutic targets. By integrating current evidence, it aims to clarify the prognostic significance and clinical applicability of these molecular markers, highlighting their role in advancing personalized strategies for the diagnosis and management of HF.