Circulating microRNAs in Atrial Fibrillation: Clinical Significance and Future Perspectives

Area of Science:

• Cardiology
• Molecular Biology
• Biomarker Discovery

Background:

• Atrial fibrillation (AF) management is challenging due to limitations in current risk prediction for individual patients.
• The molecular mechanisms underlying AF progression are not readily observable at the clinical level.
• Circulating microRNAs (miRNAs) are small non-coding RNAs found in blood, implicated in AF pathogenesis.

Purpose of the Study:

• To review the biological basis for using circulating miRNAs as biomarkers in AF.
• To summarize consistent findings from clinical studies and meta-analyses on miRNA expression in AF.
• To evaluate the potential clinical utility of miRNAs for AF diagnosis, prognosis, and treatment decisions.

Main Methods:

• Literature review of mechanistic studies on miRNAs in atrial pathophysiology.
• Systematic review and meta-analysis of clinical studies reporting miRNA expression levels in AF patients.
• Critical appraisal of evidence regarding the diagnostic and prognostic accuracy of circulating miRNAs.

Main Results:

• Mechanistic evidence supports miRNA involvement in atrial fibrosis, electrical remodeling, and inflammation.
• Consistent patterns of altered miRNA expression in AF have been identified across multiple studies.
• Current evidence is insufficient to fully support routine clinical use for diagnosis or prognosis.

Conclusions:

• Circulating miRNAs hold mechanistic plausibility as AF biomarkers.
• Translating miRNA findings into clinical practice requires further validation and standardization.
• Addressing current limitations is crucial for realizing the potential of miRNAs in personalized AF management.