Great Expectations: MicroRNA-30d and Cardiac Resynchronization Therapy
"The broken heart. You think you will die, but you just keep living, day after day after terrible day." - Charles Dickens' Great Expectations1
There seem to be as many approaches to managing heart failure as there are causal factors. Heart failure management is evolving from a one-size-fits-all approach centered around therapy with neurohormonal antagonists toward strategies tailored to provide the optimal clinical benefit based upon individual patient profile. Thus, a major collective enterprise of the translational research community has been to identify subsets of patients that will derive greater benefit from one or another management scheme. The initial observation that, like cancer and other pathologies, microRNAs are regulated in heart disease2 was coupled with observations that microRNAs are found circulating in stable form in the blood3, 4 to raise expectations that microRNAs would prove useful as disease biomarkers, providing insights into aspects of heart disease not revealed through traditional clinical testing5. In the current issue of Circulation, Melman et al propose miR-30d as a biomarker for heart failure responsiveness to cardiac resynchronization therapy6. This manuscript aptly illustrates the promise, problems, and pitfalls with the current state of evaluating microRNAs as biomarkers of cardiovascular disease. To quote Pip's sister in Great Expectations: "Answer him one question, and he'll ask you a dozen directly"1.
- Received May 11, 2015.
- Accepted May 15, 2015.