Prognostic Value of Serum MicroRNA-423-5p Levels for Cardiovascular Events in Patients with Heart Failure

Background: Patients with heart failure remain at a relatively high risk of cardiovascular events after hospital discharge, adversely affecting survival and quality of life. Recent evidence suggests that serum microRNA-423-5p may serve as a prognostic biomarker; however, data in Vietnamese populations are limited. Objectives: To evaluate the prognostic value of serum microRNA-423-5p for major adverse cardiovascular events (MACE) in patients with heart failure. Materials and Methods: A cross-sectional study with a 6-month follow-up was conducted in 250 heart failure patients at Can Tho Central General Hospital from January 2024 to November 2025. Serum microRNA-423-5p levels were measured, and patients were followed for MACE, including rehospitalization for heart failure, non-fatal myocardial infarction, cardiovascular death, and all-cause mortality. Results: Males accounted for 56.0%. Patients with LVEF < 30% had higher NT-proBNP levels and smoking prevalence compared to those with LVEF ≥ 30% (p < 0.05). At 6 months, 29.6% experienced MACE, most commonly heart failure rehospitalization (23.2%), followed by all-cause mortality (7.6%), cardiovascular death (6.0%), and myocardial infarction (1.6%). Median microRNA-423-5p levels were higher in patients with MACE 4.23 (IQR: 1.82–17.63) vs. 2.50 (IQR: 0.96–5.46), (2−ΔCt); p < 0.05. A cutoff value of 10.77 (2−ΔCt) demonstrated moderate prognostic performance (AUC = 0.652; 95% CI: 0.574–0.729; p < 0.05). Multivariable analysis identified LVEF <30% (OR = 1.94) and microRNA-423-5p (OR = 1.14) as independent predictors of MACE. Conclusions: Serum microRNA-423-5p is a useful biomarker for predicting 6-month cardiovascular events in patients with heart failure.