Circulating MicroRNAs as Potential Diagnostic Biomarkers for Heart Failure: A Systematic Review and Meta-Analysis

Background Current heart failure (HF) biomarkers (e.g., BNP/NT-proBNP) have limitations in specificity and performance in HF with preserved ejection fraction (HFpEF). Circulating microRNAs (miRNAs) are promising novel biomarkers. This study aimed to comprehensively evaluate the diagnostic stability of circulating miRNAs for HF, identify novel candidates, and prioritize them for clinical translation. Methods We conducted a systematic review and meta-analysis. PubMed, Embase, and Cochrane Central were searched from inception to March 2025. Studies comparing miRNA expression in HF versus control groups using blood or tissue samples were included. Data were extracted, and study quality was assessed using the Newcastle-Ottawa Scale (human) and SYRCLE’s tool (animal). A random-effects model pooled log odds ratios (logORs) for each miRNA. Subgroup analyses were based on species, ethnicity, and sample type. Evidence quality was graded using the GRADE framework. Results Eighty-six studies (61 human, 25 animal) with 3,023 samples were included. Meta-analysis identified 71 consistently dysregulated circulating miRNAs (58 up, 13 down) in HF. Key upregulated miRNAs included miR-21 (logOR=8.15, 95% CI: 7.55–8.74), miR-423-5p, and miR-210. Key downregulated miRNAs included miR-144 and miR-126. Subgroup analyses revealed differences by species, ethnicity (Asian vs. non-Asian), and sample type (serum vs. plasma). GRADE assessment classified five miRNAs (miR-1, miR-21, miR-221, miR-423-5p, miR-148a) as high-quality evidence. Conclusions This meta-analysis identifies a panel of circulating miRNAs with stable expression in HF, with miR-21 and miR-423-5p being the most robust. Evidence grading provides a clear priority list (e.g., miR-21, miR-423-5p) for clinical validation. Subgroup heterogeneity highlights the need for standardized protocols and precision diagnostics in future biomarker development.