Poster 043: Circulating MicroRNAs as Emerging Biomarkers in Cardiogenic Shock: Mechanistic Rationale and Clinical Implications

Background: Cardiogenic shock remains associated with high mortality despite advances in mechanical circulatory support. Current prognostic markers reflect late physiologic decompensation. Circulating microRNAs, particularly miR-21, regulate fibrosis, inflammation, and apoptosis and may provide earlier molecular insight into myocardial injury and shock severity.

Methods: We performed a focused review of preclinical and clinical studies evaluating circulating microRNAs in acute cardiac injury syndromes relevant to cardiogenic shock, including acute myocardial infarction and acute heart failure. Emphasis was placed on microRNAs implicated in myocardial remodeling, inflammation, hypoxia signaling, and apoptosis. Particular attention was given to miR-21 due to its mechanistic involvement in cardiac stress pathways and reproducible detection in plasma. Additional candidate microRNAs were evaluated for biological relevance, myocardial specificity, and potential clinical utility. Findings were synthesized to highlight mechanistic overlap with cardiogenic shock pathophysiology and to identify translational gaps and future research directions.

Outcome: Multiple circulating microRNAs demonstrate mechanistic relevance to cardiogenic shock–related pathways. miR-21 consistently emerges as a central regulator of fibrosis, inflammation, apoptosis, and ventricular remodeling, with elevated levels associated with adverse outcomes in acute myocardial infarction and heart failure populations. Other microRNAs provide complementary signals: miR-1 and miR-133a reflect acute cardiomyocyte injury; miR-208a and miR-499 offer high myocardial specificity but limited temporal windows; miR-320a and miR-20b capture ischemic, metabolic, and hypoxia-driven stress; and miR-122-5p reflects systemic hypoperfusion and end-organ injury. Collectively, these findings suggest that no single microRNA captures the full spectrum of cardiogenic shock biology, but miR-21 is uniquely positioned as an integrative marker of myocardial stress and maladaptive remodeling.

Conclusion: Circulating microRNAs, particularly miR-21, offer biologically plausible and clinically relevant insight into cardiogenic shock beyond traditional markers. Integration of molecular biomarkers with clinical staging may improve early risk stratification. Prospective studies are needed to define optimal timing, validation, and additive prognostic value.