Frontiers in Cardiovascular Medicine最新文献

{"title":"Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study.","authors":"Marta Wleklik, Christopher S Lee, Maria Jędrzejczyk, Heba Aldossary, Izabella Uchmanowicz","doi":"10.3389/fcvm.2025.1566400","DOIUrl":"10.3389/fcvm.2025.1566400","url":null,"abstract":"<p><strong>Introduction: </strong>Cognitive decline in older adults with heart failure (HF) may be influenced by educational level and depressive symptoms. This study assesses the impact of these factors on cognitive function in this patient population to mitigate cognitive decline and improve overall health in this vulnerable population.</p><p><strong>Aim: </strong>To identify the predictors of cognitive impairment in older patients with heart failure using a longitudinal mixed-model analysis.</p><p><strong>Material and methods: </strong>A 250 HF patients aged 60 and older with an MMSE score ≥24 was evaluated. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), mental health with the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), and nutritional status with the Mini Nutritional Assessment (MNA). Data were collected in three stages: baseline during hospitalization and at two subsequent hospital follow-ups. A linear mixed model analyzed the relationship between educational level, depressive symptoms, and MMSE scores, with a significance level set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>The mean baseline MMSE score was 26.5 (SD = 2.1), suggesting good initial cognitive function among participants. Results from the linear mixed model indicated that each additional year of education correlated with a 0.161-point increase in MMSE scores (95%CI: 0.1-0.222, <i>p</i> < 0.001). Conversely, higher depressive symptoms were associated with poorer cognitive outcomes; specifically, each one-point increase in the HADS depression subscale corresponded to a 0.115-point decrease in MMSE scores (95%CI: -0.183 to -0.046, <i>p</i> = 0.001). Other factors, including age, sex, residence, and various comorbidities, did not show statistically significant associations with cognitive decline. At each stage of the study, approximately 8%, 11%, and 11% of patients, respectively, scored above the HADS cut-off for anxiety or depression, while an additional 13%, 12%, and 15% showed borderline scores. According to the PHQ-9, depressive symptoms of varying severity were present in 54% of patients at Stage I and II, and in 58% at Stage III.</p><p><strong>Conclusions: </strong>This study shows that greater educational background is associated with improved cognitive function, while higher levels of anxiety and depression are linked to cognitive decline in older adults with heart failure. These results highlight the importance of integrating mental health and education in interventions aimed at enhancing cognitive health in this population.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1566400"},"PeriodicalIF":2.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The multiple linear regression model: to predict peak metabolic equivalents and peak oxygen pulse in patients with coronary artery disease after percutaneous coronary intervention.","authors":"Wenqing Xu, Yin Xiang, Bo Liu, Jianhua Yan, Tingting Zhang, Wanqi Yu, Jia Han, Shu Meng","doi":"10.3389/fcvm.2025.1459411","DOIUrl":"10.3389/fcvm.2025.1459411","url":null,"abstract":"<p><strong>Background: </strong>The clinical indicators of patients with coronary artery disease (CAD) often affect their prognosis. Cardiopulmonary Exercise Testing (CPET) can effectively evaluate the cardiopulmonary ability of CAD patients. The objective of this research was to explore the correlation between some clinical indicators and peak metabolic equivalents (peak METs) and peak oxygen pulse (O₂P_peak) in patients with CAD. Regression equations were further constructed for indicators with significant correlations to predict peak METs and O₂P_peak.</p><p><strong>Methods: </strong>152 CAD patients were recruited (M: F = 109:43, age = 64.47 ± 7.80 years, including 32 patients with chronic myocardial infarction, 46 with frailty, 93 with hypertension, and 48 with diabetes). All participants had blood biochemistry analysis, cardiac ultrasound, CPET and five time sit-to-stand (FTSTS) test. CPET was tested according to an incremental loading scheme of 10-15 w/min and peak METs, O₂P_peak were recorded. Stepwise multifactorial linear regression was used to determine which clinical variables should be adjusted to improve peak METs and O₂P_peak.</p><p><strong>Results: </strong>Results of multifactorial linear regression showed 2 equations: peak METs = 6.768-0.116*BMI + 0.018*Hgb-0.026*age-0.005*Gensini score (Adjusted R² = 0.301, F = 17.239, <i>p</i> < 0.001); O₂P_peak = -1.066 + 0.264*BMI + 0.049*Hgb-0.035*age (Adjusted R² = 0.382, F = 32.106, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>BMI, Hgb, age and Gensini score can be used to predict peak METs and BMI, Hgb and age can be used to predict O₂P_peak in patients with CAD clinically. Thus, tailored exercise program should be prescribed for individual CAD patient undergoing cardiac rehabilitation and modifying clinical factors such as BMI, Hgb and Gensini score will help to improve their cardiorespiratory fitness and quality of life.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1459411"},"PeriodicalIF":2.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effects of metformin and empagliflozin on cardiac function in heart failure with preserved ejection fraction mice.","authors":"Xiehong Liu, Huiqi Zhao, Sisi Liu, Siao Wen, Wenjuan Fan, Qiong Xie, Bo Cui, Lin Zhou, Jianqiang Peng, Hongwei Pan, Zhaofen Zheng, Qinghai Zhang","doi":"10.3389/fcvm.2025.1533820","DOIUrl":"10.3389/fcvm.2025.1533820","url":null,"abstract":"<p><strong>Purpose: </strong>Recent evidence suggests that empagliflozin (EMPA) and metformin (MET) may improve prognosis in heart failure with preserved ejection fraction (HFpEF) patients. This study aims to compare their effects on cardiac structure and function in HFpEF.</p><p><strong>Methods: </strong>Male C57BL/6J mice were fed a high-fat diet with L-NAME for 8 weeks to induce HFpEF, followed by 4 weeks of MET or EMPA treatment. Cardiac structure and function were assessed. Network pharmacology and bioinformatics identified key targets, validated by RT-qPCR and WB.</p><p><strong>Results: </strong>EMPA-treated mice lost weight, unlike MET-treated ones. MET reduced systolic blood pressure significantly. Both treatments improved glucose tolerance; MET enhanced insulin sensitivity. EMPA increased exercise tolerance by extending exhaustion distance. Both treatments improved diastolic function, reduced heart weight, and attenuated myocardial fibrosis and hypertrophy. Plasma NT-proBNP levels were slightly elevated but not significant. EMPA downregulated HSP90 mRNA and protein expression; both drugs downregulated TGFβ.</p><p><strong>Conclusion: </strong>MET and EMPA improve cardiac fibrosis, diastolic function, and pulmonary congestion in HFpEF mice. MET acts by downregulating TGFβ, while EMPA affects collagen metabolism and downregulates HSP90 and TGFβ. These findings offer insights into HFpEF treatment.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1533820"},"PeriodicalIF":2.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of a PANoptosis-related gene signature reveals therapeutic potential of SFRP2 in pulmonary arterial hypertension.","authors":"Li Li, Mukamengjiang Juaiti","doi":"10.3389/fcvm.2025.1521087","DOIUrl":"10.3389/fcvm.2025.1521087","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arterial hypertension (PAH) is a serious condition marked by elevated pulmonary artery pressure, often progressing to right heart failure and high mortality. PANoptosis, an inflammatory form of programmed cell death, remains understudied in the context of PAH. This study aims to identify and validate PANoptosis-related signature genes in PAH using bioinformatics analysis alongside <i>in vivo</i> and <i>in vitro</i> experiments, seeking to uncover its potential role in disease progression.</p><p><strong>Methods: </strong>PAH-related datasets and PANoptosis-associated genes were sourced from the Gene Expression Omnibus (GEO) database and prior studies. Feature genes were identified through weighted gene co-expression network analysis (WGCNA), least absolute shrinkage and selection operator (LASSO), and random forest (RF) algorithms, with validation performed on external datasets. The immune landscape in PAH was characterized using the CIBERSORT algorithm, providing insights into immune cell composition and its role in disease progression. Gene expression was further validated using a rat PAH model and pulmonary artery fibroblasts (PAAFs), while hub gene functions were investigated at the cellular level through Western blot, CCK-8, and flow cytometry assays.</p><p><strong>Results: </strong>Through integrated transcriptomic analysis, SFRP2 was identified as a feature gene related to PAH and PANoptosis. Experimental validation was conducted in MCT-induced rat PAH models and TGF-β1-induced PAAFs, confirming SFRP2's role in regulating fibroblast proliferation and anti-apoptotic processes. The diagnostic model derived from dataset analysis exhibited high accuracy in diagnosing PAH, while immune cell infiltration analysis highlighted immune dysregulation associated with the condition.</p><p><strong>Conclusion: </strong>SFRP2 was identified as a potential biomarker for PAH, impacting cell proliferation and resistance to apoptosis, thus providing new insights for PAH prevention and treatment.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1521087"},"PeriodicalIF":2.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful treatment of massive biventricular thrombi associated with myocarditis: a case report.","authors":"Chunshui Liang, Hong Liu, Zhezhe Cao, Tianbo Li, Yong Wang, Yingbin Xiao, Ruiyan Ma","doi":"10.3389/fcvm.2025.1530548","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1530548","url":null,"abstract":"<p><strong>Background: </strong>Massive biventricular thrombi associated with myocarditis are rare and pose significant management challenges.</p><p><strong>Case presentation: </strong>A 24-year-old male from a plateau region presented with dyspnea, chest pain, and cerebral infarction/hemorrhage. Imaging revealed giant biventricular thrombi (left: 81 × 62 × 59 mm; right: 59 × 16 mm) and LVEF of 25%.</p><p><strong>Management: </strong>Multidisciplinary therapy included anticoagulation and GDMT.</p><p><strong>Outcomes: </strong>Complete thrombus resolution occurred by 10 weeks, with improved cardiac function (LVEF 48%) and no recurrent embolism.</p><p><strong>Conclusion: </strong>Drug therapy may be effective for massive biventricular thrombi in myocarditis.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1530548"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare and life-threatening iliac vein stent infection following radiotherapy: a case report emphasizing clinical urgency and preoperative stent evaluation.","authors":"Jianyu Liao, YuKui Ma, Zhoupeng Wu, Xinyan Wang, Jichun Zhao","doi":"10.3389/fcvm.2025.1532300","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1532300","url":null,"abstract":"<p><p>This case report discussed a 43-year-old female who underwent multiple radiotherapy sessions after cervical cancer surgery and experienced serious complications due to simultaneous iliac vein stent placement immediately after thrombus aspiration without adequate evaluation of the indication for stent placement. Two months after radiotherapy, the patient developed right lower limb edema and pain, which led to the discovery of an iliac vein thrombosis. Subsequent stent placement without thorough evaluation resulted in severe complications, including infection and sepsis. Despite initial symptom relief, the patient was readmitted with high fever and severe pain, and imaging revealed gas around the stent, indicating infection. An exploratory laparotomy uncovered a large abscess and a colonic fistula. The stents were removed, and the patient underwent aggressive anti-infection treatment involving meropenem and vancomycin, along with surgical repair of the fistula. This case highlights the importance of accurate diagnosis and careful consideration of stent placement in preventing severe outcomes, including the rare but serious risk of venous stent infections requiring surgical intervention.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1532300"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we know more about atherosclerosis in cyanotic patients with congenital heart disease-the potential role of sphingosine-1-phosphate?","authors":"Sonia Alicja Nartowicz, Marcin Gabriel, Magdalena Janus, Artur Cieślewicz, Katarzyna Malesza, Agnieszka Bartczak-Rutkowska, Maciej Lesiak, Olga Trojnarska","doi":"10.3389/fcvm.2025.1531136","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1531136","url":null,"abstract":"<p><strong>Background and aims: </strong>Progress in cardiology has extended the lifespan of patients with congenital heart defects (CHD). Cyanotic patients are exposed to typical diseases of adulthood, including atherosclerosis. Rheological changes typical of cyanosis affect the vascular endothelium's function and may promote atherosclerosis development. We assessed the endothelial function and its relationship to biochemical parameters, particularly sphingosine-1-phosphate, in cyanotic CHD patients.</p><p><strong>Method: </strong>A cross-sectional study including 36 adult CHD cyanotic patients [(12 males) (39 median, 19-73 years)] with arterial blood oxygen saturation less than 92% and 30 healthy controls [(11 males) (38.5 median, 26-59 years)] was performed. All patients underwent clinical examination, blood sampling, and ultrasonography, during which endothelial function was assessed using intima-media thickness (IMT) and flow-mediated dilatation (FMD).</p><p><strong>Results: </strong>We did not demonstrate any difference between CHD patients and the control group in the IMT complex and FMD. Patients with cyanosis are characterized by higher S1P serum levels (<i>p</i> = 0.04), lower ApoM (<i>p</i> = 0.04), and HDL concentrations (<i>p</i> = 0.02). Only FMD correlated positively with HDL cholesterol (<i>p</i> = 0.02) concentration. The IMT complex correlates positively only with BMI (<i>p</i> = 0.04). No factor was statistically significant in the multiple logistic regression model for FMD <6.5%.</p><p><strong>Conclusions: </strong>The values of the analyzed biochemical and clinical factors (except for the reduced HDL fraction), the lack of inflammatory factor activity, and the increased S1P concentration indicate the dominance of antiatherosclerotic activity in this population. FMD and IMT are preserved, which suggests that the risk of early atherosclerotic changes in this group is comparable to the remaining population.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1531136"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary artery rupture by pulmonary artery catheter in cardiac surgery: a case report and review of literature.","authors":"Yuta Nakamura, Keita Saku, Suzu Homma, Yoko Midorikawa, Tsuyoshi Yamabe, Takashi Ota","doi":"10.3389/fcvm.2025.1567723","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1567723","url":null,"abstract":"<p><p>The pulmonary artery catheter (PAC) is widely used in cardiac surgery for monitoring hemodynamics and cardiovascular function. Complications including pulmonary artery injury causing massive intratracheal hemorrhage are rare but can be life-threatening. We report a case of intratracheal bleeding (3,000 ml) caused by PAC-induced pulmonary artery injury during cardiac surgery and after weaning from cardiopulmonary bypass (CPB). During surgery for acute type A aortic dissection followed by CPB weaning, pulsatile bleeding from the endotracheal tube and desaturation were observed. We reinstituted CPB and placed a right-sided double-lumen tube to compress the injured site of the lung and protect the contralateral site. Following initial bleeding control, we conducted coil embolization to treat tracheal obstruction by a pseudoaneurysm on day 7. A review of 21 recent cases of pulmonary artery injury during cardiac surgery showed that most cases occurred during CPB weaning, manifested hemoptysis, and were treated by coil embolization. This case underscores the importance of enhanced PAC monitoring even after CPB weaning and the need for prompt evaluation and intervention when pulmonary artery injury is suspected during cardiac surgery.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1567723"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripartum cardiomyopathy: a review of prevalence and treatment trends from an African perspective.","authors":"Kedir Negesso Tukeni, Elsah Tegene Asefa, Tamirat Godebo Woyimo, Esayas Kebede Gudina, Heidi Estner, Nikolaus Alexander Haas","doi":"10.3389/fcvm.2025.1568493","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1568493","url":null,"abstract":"<p><p>Peripartum cardiomyopathy (PPCM) is a type of dilated cardiomyopathy that develops in women without a history of heart disease during the last trimester of pregnancy or within 6 months postpartum. It is one of the primary causes of heart failure during pregnancy, which increases peripartum morbidity and mortality. PPCM can cause significant left ventricular dysfunction, progressive heart failure, and refractory cardiogenic shock, resulting in increased maternal morbidity and mortality. Dyspnea, exhaustion, and lower extremity edema are common symptoms and are often misdiagnosed as normal postpartum changes, demanding careful assessment with echocardiography. Furthermore, diagnosis and treatment are often delayed due to insufficient awareness among healthcare providers, with varying definitions of the disease across countries. Its underlying causes remain unclear, although recent studies point to a potential prolactin-oxidative stress mechanism that might lead to potential future treatments. Clinical care follows basic heart failure management guidelines while taking medication teratogenicity into account. The prognosis varies geographically based on the level and pattern of treatment, with a considerable number of patients displaying partial recovery. The prevalence and treatment patterns of these patients in Africa, including the benefits and safety profiles of bromocriptine, are reviewed here, to identify directions in its prospective use in different forms of cardiomyopathies based on the available literature.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1568493"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis.","authors":"Taha Al-Maimoony, Khairallah Al-Matari, Abdulhafeedh Al-Habeet, Nouradden Noman Aljaber, Mohamad Al-Marwala, Salah Al-Hashmi","doi":"10.3389/fcvm.2025.1465866","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1465866","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of using off-label direct oral anticoagulants (DOACs) compared to warfarin for treating left ventricular (LV) thrombi using inverse probability-of-treatment weighting (IPTW) analysis.</p><p><strong>Methods: </strong>An observational study of 302 eligible patients with newly diagnosed LV thrombi was conducted at a tertiary referral center from January 2020 to December 2023. Of the 302 patients, 183 received treatment with DOACs, while 119 were treated with warfarin. The primary endpoint was defined as the complete resolution of the thrombus within one month. The secondary endpoints were defined as the complete resolution of the thrombus within six months along with the following events, including minor and major bleeding events, a systemic embolism, transient ischemic attack, stroke, and all-cause mortality. Alongside individual endpoints, a composite endpoint involving ischemic stroke or mortality was also examined.</p><p><strong>Results: </strong>IPTW estimates suggested that DOACs were significantly more effective than warfarin in resolving LV thrombus within one month (RR: 1.38; 95% CI: 1.14-1.66; <i>p</i>-value: <0.001). However, there were no significant differences between the two groups in all secondary endpoints, except that DOACs were significantly associated with a lower incidence of the composite outcome of ischemic stroke and all-cause mortality (RR: 0.96; 95% CI: 0.93-0.99; <i>p</i>-value: 0.040). In DOAC subgroup analysis, only rivaroxaban demonstrated earlier and superior resolution of LV thrombus with non-inferior safety when compared to warfarin.</p><p><strong>Conclusions: </strong>DOACs, specifically rivaroxaban, could be a promising therapeutic alternative for treating LV thrombi. Further research through randomized clinical trials is necessary to confirm our findings.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1465866"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}