{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T19:30:54Z","timestamp":1785439854462,"version":"3.56.0"},"reference-count":110,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This narrative review evaluates the potential of Tetranectin (TN) and Paraoxonase-1 (PON1) to bridge the gap between biological pathology and clinical risk stratification by mapping the \u201cFibrosis-Oxidative Axis\u201d. Materials and Methods: A targeted literature search was conducted using Scopus, PubMed, and Google Scholar to identify studies examining the diagnostic and prognostic value of TN and PON1 in heart failure (HF). Evidence was synthesized qualitatively to analyze their roles in structural fibrosis and oxidative defense. Results: Tetranectin functions as a structural indicator, where its dynamics reflect fibroblast activation, extracellular matrix (ECM) deposition, and protein sequestration during tissue remodeling. On the other hand, PON1 serves as a functional metabolic barometer; its reduced activity correlates with systemic oxidative burden, loss of endothelial protection, and pro-inflammatory signaling. These markers capture a bidirectional pathology where oxidative injury drives fibrotic remodeling, which subsequently continue metabolic dysfunction. A dual-biomarker profile is proposed to stratify disease activity: early-stage metabolic stress (reduced PON1) precedes structural changes, while progressive HF involves active fibrosis (altered TN) alongside persistent oxidative injury. Conclusions: The combined assessment of TN and PON1 offers a complementary approach to HF profiling, potentially refining risk stratification beyond hemodynamic parameters. However, clinical implementation requires large-scale validation to address standardization issues and specificity limitations regarding multimorbidity.<\/jats:p>","DOI":"10.3390\/medicina62020284","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T12:49:44Z","timestamp":1770036584000},"page":"284","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tetranectin and Paraoxonase-1 as Markers of Heart Failure"],"prefix":"10.3390","volume":"62","author":[{"given":"Paula Alexandra","family":"Vulciu","sequence":"first","affiliation":[{"name":"Department of Biochemistry, \u201cVasile Goldis\u201d Western University, B-dul Revolutiei Nr. 96, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolae Catalin","family":"Valea","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, \u201cVasile Goldis\u201d Western University, B-dul Revolutiei Nr. 96, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Zdremtan","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, \u201cVasile Goldis\u201d Western University, B-dul Revolutiei Nr. 96, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chioreanu","family":"Alexandru","sequence":"additional","affiliation":[{"name":"Department of ENT, \u201cVasile Goldis\u201d Western University, B-dul Revolutiei Nr. 96, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0320-6904","authenticated-orcid":false,"given":"Norberth-Istvan","family":"Varga","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imola","family":"Donath-Miklos","sequence":"additional","affiliation":[{"name":"Department of Physiology, \u201cVasile Goldis\u201d Western University, B-dul Revolutiei Nr. 96, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Daniela","family":"Mot","sequence":"additional","affiliation":[{"name":"Department of General Medicine, \u201cVasile Goldis\u201d Western University, B-dul Revolutiei Nr. 96, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Puschita","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cVasile Goldis\u201d Western University, B-dul Revolutiei Nr. 96, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global Burden of Heart Failure: A Comprehensive and Updated Review of Epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc. 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