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The past decade has witnessed an exponential proliferation of new biomarkers that are useful in evaluating patients with heart failure (reviewed in 1). Indeed, 2 biomarkers, brain natriuretic peptide and N-terminalprobrain natriuretic peptide (BNP) are Food and Drug Administration–approved for the diagnosis of patients with heart failure, whereas BNP, N-terminalpro-BNP, galectin-3, and soluble ST-2 are Food and Drug Administration–approved for determining the prognosis of patients with heart failure. In this issue of Circulation Research , Matsumoto et al2 report that several p53-responsive microRNAs (miRs), including miR-192, miR-194, and miR-34a, were elevated in the sera of selected patients enrolled in the Osaka Acute Coronary Insufficiency study (n=8603 patients), who developed heart failure 1 year after acute myocardial infarction. Given that p53 has been implicated in the development of heart failure in mice,3 these findings are of potential interest both from a mechanistic standpoint, as well as clinically from a diagnostic standpoint. In this study, the authors examined a panel of 377 microRNAs in registry patients who developed heart failure (n=7 patients), and then confirmed their findings in a validation cohort of 21 patients. The authors reported previously that miR-192 was significantly ( P =0.04) elevated in selected registry patients.4 Noting that miR-192 was responsive to p53, in this study, the authors rescreened the sera of heart failure patients and identified significant increases in the levels of 2 additional p53-responsive microRNAs, namely miR-194 (increased ≈6-fold) and miR-34a (increased ≈3-fold). The presence or absence of heart failure in the registry was determined from a retrospective chart review; however, the criteria that were used to diagnose heart failure were not specified. Remarkably, the levels of miR-192, miR-194, and miR-34a were highly enriched in the exosome fraction of the heart failure patients when compared with control subjects, whereas the levels of miR-192, miR-194, …

Circulating p53-Responsive MicroRNAs as Predictive Biomarkers in Heart Failure After Acute Myocardial Infarction