Heart failure affects millions of people worldwide. However, did you know that women are often misdiagnosed or receive their diagnosis too late?
As the term might suggest, heart failure means the heart is failing in pumping enough blood to the body’s cells
There are two main types of heart failure. In heart failure with reduced ejection fraction (HFrEF), the heart has a diminished ability to pump blood. In heart failure with preserved ejection fraction (HFpEF), the heart struggles to fill with blood.
HFpEF is the most common type of heart failure, and particularly prevalent among elderly women, but it is also the hardest to diagnose.
Different types of heart failure require different treatments
The various types of heart failure require different therapeutic strategies, making accurate diagnosis critical.
“We need to differentiate between the two types of heart failure so that we can provide accurate diagnoses to patients and, consequently, the most effective treatment,” says Reza Parvan, a PhD student at the Institute for Experimental Medical Research (IEMR) at the University of Oslo and Oslo University Hospital.
Lack of effective biomarkers for diagnosing both types
Biomarkers are crucial tools in medicine, often used to provide precise diagnoses for patients.
While there are several biomarkers available for diagnosing the first type of heart failure, currently, there are no biomarkers adequate enough to assist doctors in distinguishing between the two types of heart failure, thus providing meaningful information to patients.
Small molecules may provide answers
Parvan and his colleagues may have found a solution. They are investigating whether small molecules can indicate the type of heart failure a person has.
“We have explored how certain small molecules can function as biomarkers for diagnosing heart failure,” he explains.
The researchers have identified tiny molecules in the blood known as microRNAs. These small RNA molecules reflect gene expression and may indicate disease status and severity.
They have successfully identified a panel consisting of four such microRNAs.
This new biomarker panel can differentiate between patients with heart failure and healthy individuals, as well as effectively distinguish between the two main types of heart failure.
Significant findings for diagnosing women with heart failure
This discovery is particularly significant for women.
“We found that two of these microRNAs are especially relevant for women,” Parvan notes.
Thus, the researchers have identified several biomarkers that also take gender differences into account.
“Our methods can lead to more accurate diagnoses of heart failure, particularly for the often-overlooked HFpEF,” says Parvan.
“Considering that the majority of HFpEF patients are women and this is the most common form of heart failure among the elderly, this is an important advancement,” he adds.
Accurate diagnoses will improve patients' quality of life
Approximately 26 million people worldwide are diagnosed with heart failure.
“Estimates suggest that the actual number could exceed 37 million. We believe the difference in numbers may be due to undiagnosed cases of heart failure,” Parvan explains.
“More precise diagnoses lead to better management of the disease and can potentially improve the quality of life for many patients,” he adds.
Predicting the risk of heart failure
Parvan and his colleagues have also shown that these molecules can be used to predict the risk of developing heart failure and related complications, such as hospitalizations, readmissions and heart-related deaths.
Heart failure is the leading cause of hospitalizations globally.
“Over half of patients are readmitted to the hospital within six months of discharge,” he states.
Even more concerning, he points out, is the long-term prognosis for individuals with heart failure.
“The prognosis indicates a mortality rate of 60 percent within five years of diagnosis. All forms of heart failure have a poorer prognosis compared to individuals without the condition,” he says.
Testing in patient groups
Moving forward, the researchers plan to conduct clinical validation of these panels, meaning they will test them in various patient cohorts.
“This will ensure that our results are robust and reliable,” Parvan says.
They will also explore the inclusion of other types of biomarkers, such as proteins, laboratory analyses, imaging technologies, and genetic markers in patients who have undergone heart or liver transplants.
If successful, this could assist doctors in making more accurate diagnoses, especially in women.
At the forefront of innovative medical diagnostics
The research conducted by Parvan and his colleagues represents a significant step towards more tailored medicine in heart failure treatment.
“With this research, we position ourselves at the forefront of innovative medical diagnostics, focusing on future developments of RNA-based test kits,” explains Gustavo J. J. da Silva, postdoctoral fellow at Institute for Experimental Medical Research.
Da Silva notes that their developments are not limited to RNA-based biomarkers or heart failure alone.
“The method we have developed proves robust enough to be applied to other patient groups as well, including other cardiac patients and non-cardiac patients,” he states.
“We may be able to identify other types of markers, from proteins and genetic markers to imaging technologies. This opens the possibility of developing multimodal biomarker panels for various clinical needs, not just limited to heart failure,” he concludes.
References
Parvan, R., Becker, V., Hosseinpour, M.?et al.?Prognostic and predictive microRNA panels for heart failure patients with reduced or preserved ejection fraction: a meta-analysis of Kaplan–Meier-based individual patient data.?BMC Med?23, 409 (2025). https://doi.org/10.1186/s12916-025-04238-0
Parvan, R., Rolim, N., Gevaert, A. B. et al. Multi-microRNA diagnostic panel for heart failure with preserved ejection fraction in preclinical and clinical settings. ESC Heart Failure (2025). https://doi.org/10.1002/ehf2.15324
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