European Journal of Internal Medicine最新文献

Left ventricular hypertrophy (LVH) is the most common hypertension-related cardiac disorder. Indeed, it is present in about 50% of patients with hypertension when examined by echocardiography and up to 20-30% when examined by electrocardiogram (ECG). The presence of LVH may be related to safety concerns when treating hypertension because data from large outcome trials in middle-aged and older patients have shown increased mortality if systolic blood pressure (BP) is lowered <130 mmHg. LVH is only briefly mentioned in the 2024 ESC Hypertension Guideline and in the 2025 AHA/ACC Hypertension Guideline. This review therefore discusses the potential consequences of a low target BP in hypertensive patients with LVH. The Losartan Intervention for Endpoint Reduction Study (LIFE) included 9,193 patients 55-80 years old with hypertension and ECG-LVH. A time-varying LIFE analysis showed that achieving systolic BP ≤130 mmHg led to a 37% increase in all-cause mortality (p=0.005) and a 32% increase in cardiovascular mortality (p=0.08) compared to patients who achieved systolic BP of ≥142 mmHg. In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) Trial, which included patients aged ≥50 years with concomitant cardiovascular risk factors, patients with ECG-LVH (n=2,458) who achieved average systolic BP <130 mmHg (n=305) through 4 years had higher all-cause and cardiac mortality than patients with systolic BP 130-139 mmHg (HR=1.74, 95% CIs 1.17-2.60) or systolic BP ≥140 mmHg (HR=1.98, CIs 1.06-3.70). LIFE and VALUE suggested an increased mortality when lowering systolic BP <130 mmHg in patients 50 years and older with ECG-LVH. While further research is needed to better define a target systolic BP in patients with hypertension and ECG-LVH, caution is warranted in lowering systolic BP <130 mmHg in middle-aged and older hypertensive patients with ECG-LVH.

Omics technologies analyze comprehensive molecular datasets, enabling the detailed characterization of pathological processes. Genomic, transcriptomic, proteomic, and metabolomic approaches, as well as emerging single-cell and spatial omics, enhance biomarker discovery, early diagnosis, patient stratification, therapy selection, and prognosis. Multi-omics integration, combined with artificial intelligence (AI), could facilitate precision medicine by predicting treatment responses, uncovering disease heterogeneity, and defining personalized treatment. Clinical trials demonstrate the translational potential of omics across oncology, cardiovascular, neurological, and other conditions. Despite rapid technological progress, challenges remain, including data complexity, costs, standardization, and clinical interpretability. Ongoing efforts in guideline development, AI-assisted integration, and standardized workflows aim to bridge the gap between research and routine practice. This review highlights the potential clinical applications of omics and current guidelines for their implementation in routine practice.

Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease with variable manifestations across Mediterranean regions. This study compares FMF cohorts from Italy (Apulia) and Lebanon. We analyzed a cohort of 443 FMF patients, 165 Italians (females: males = 90:75) and 278 Lebanese (females: males = 173:105). Clinical records/interviews provided data on demographics, MEFV genetic testing, and treatments. A 55-item questionnaire in 54 Italians and 42 Lebanese patients assessed disease knowledge, management, misdiagnoses, attack frequency (yearly), duration (days), body temperature, symptoms prevalence and frequency, and severity score before/after treatment. Italians were significantly older at disease onset, diagnosis, and had longer diagnostic delay than Lebanese patients (p < 0.00001). The most common MEFV variants were E148Q and R202Q in Italians, and M694V and E148Q in Lebanese, with fewer pathogenic and homozygous cases in Italians. Italian patients had lower prevalence of FMF symptoms (10-92% vs. 30-99%; p < 0.00001) and fewer attacks. All Italians received treatment compared to 88.5% of Lebanese. Colchicine was first-line treatment, while biological drug use was higher in Italians. In the subgroups study, Italians reported lower disease knowledge and were followed up mainly by internists, while Lebanese were followed up by gastroenterologists or pediatricians. Italians were misdiagnosed with appendicitis, whereas Lebanese were misdiagnosed with gastrointestinal diseases. Italians exhibited lower symptom frequency, lower severity scores, and a better response compared to Lebanese patients. In conclusion, FMF presentation differed by country, with Italians showing milder symptoms and better treatment response, while Lebanese showed severe symptoms linked to pathogenic MEFV variants. Gene-environment interactions require further studies.

Background: The risk-benefit profile of direct oral anticoagulants (DOACs) in kidney transplant recipients (KTRs) with atrial fibrillation (AF) remains under-investigated.

Purpose: To evaluate the safety and efficacy of DOACs compared with vitamin K antagonists (VKAs) in KTRs with AF.

Methods: Retrospective analysis from TriNetX network. Adult KTRs with AF were included. Patients with mechanical valves, antiphospholipid syndrome, or an estimated eGFR <15 mL/min/1.73 m² were excluded. Anticoagulated patients were stratified into two cohorts (DOACs versus VKAs) . The first 3 months post-transplant were excluded, and follow-up for outcomes started at 9 months post-transplant and continued for 12 months thereafter. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was a composite of all-cause death, thromboembolic events, major bleeding. Secondary outcomes included each component of the composite outcome and kidney transplant rejection.

Results: Of the 1367 KTRs with AF, 695 received DOACs (65.0 ± 10.0 years, 30.5% female), while 672 received VKAs (64.0 ± 10.1 years, 29.9% female). After matching, each cohort included 553 patients. At one-year follow-up, compared with VKAs, DOACs were associated with a lower risk of the composite outcome (HR 0.66, 95%CI 0.50-0.87), and kidney transplant rejection (HR 0.46, 95%CI 0.30-0.71). A non-significant trend was observed toward a lower risk of all-cause death (HR 0.64, 95%CI 0.41-1.01), major bleeding (HR 0.66, 95%CI 0.43-1.01), thromboembolic events (HR 0.68, 95%CI 0.43-1.07).

Conclusion: In this real-world cohort of KTRs with AF, DOACs use was associated with lower risk of the composite outcome and kidney transplant rejection.