Circulating microRNAs in post myocardial infarction remodeling: toward precision cardiology

Post-myocardial infarction (MI) ventricular remodeling is a major cause of heart failure, despite advances in revascularization and pharmacotherapy. Circulating microRNAs (miRNAs) are emerging as biomarkers for risk stratification and therapeutic targeting. This letter reviews their role in apoptosis, inflammation, and fibrosis, highlights studies from Europe, Asia, and North America, and discusses technological advances, including exosome-based miRNA panels and machine learning models. Limitations include analytical variability, limited geographic representation, and lack of integration into clinical care. Recommendations include standardizing methods, conducting large international studies, and developing actionable miRNA algorithms. Integrating miRNA profiling into post-MI care has the potential to improve risk assessment, personalize therapy, and reduce the burden of heart failure.