European Journal of Internal Medicine最新文献

英文中文

Bronchoscopy, ventilator dose and outcomes in severe CAP: Reading the sex signal. Author's reply 严重CAP患者的支气管镜检查、呼吸机剂量和结局：解读性别信号。作者的回答。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106658

Nicolas Garin, Despoina Koulenti, Virginie Prendki, Jordi Rello

引用次数: 0

West Nile virus infection: New guitars in town for the internal medicine community 西尼罗病毒感染：内科医学界的新吉他。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106618

Raffaella Gallo, Iolanda Cafarella, Fabian Patauner, Lorenzo Bertolino, Emanuele Durante-Mangoni

引用次数: 0

An exploratory model for short-term risk stratification in intermediate-high-risk pulmonary embolism running head: The STAMP score STAMP评分：中高危肺栓塞患者短期风险分层的探索性模型：STAMP评分。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106484

Marco Zuin , Claudio Bilato , Iolanda Enea , Amedeo Bongarzoni , Franco Casazza , Loris Roncon , Cecilia Becattini

Background

Intermediate-high-risk pulmonary embolism (PE) patients are at increased risk of sudden clinical deterioration within the first hours after symptom onset.

Objective

We aimed to develop and validate a practical prediction model and scoring system for identifying intermediate-high-risk PE patients at elevated risk of 48-hour clinical deterioration after symptom onset.

Methods

The STAMP score was developed using data from 450 intermediate-high-risk PE patients enrolled in the Italian Pulmonary Embolism Registry (ClinicalTrials.gov: NCT01604538), incorporating demographic, clinical, and imaging variables identified through multivariable analyses.

Results

A derivation cohort of 270 patients was used to create the score, which was subsequently validated in 180 patients. In the derivation cohort, multivariate analysis identified five independent predictors of 48-hour clinical deterioration: age ≥65 years (1 point), chest pain (1 point), syncope (2 points), TAPSE/PASP ≤0.33 (2 points), and mean arterial pressure (MAP) ≤81.5 mmHg (2 points). Based on the total score, patients were stratified into low (0–2 points), intermediate (3–5 points), and high (6–8 points) probability groups, with event rates significantly increasing across categories (p<0.001) in both derivation and validation cohorts. The STAMP score demonstrated good diagnostic performance, with areas under the curve of 0.86 and 0.85, C-statistics of 0.81 and 0.80, and Hosmer–Lemeshow p-values of 0.47 and 0.45, respectively.

Conclusions

The STAMP score is a novel, simple, and accurate tool that enhances early risk stratification in intermediate-high-risk PE patients, improving the identification of those at greatest risk of 48-hour clinical deterioration.

背景：中高危肺栓塞（PE）患者在症状出现后的第一个小时内临床突然恶化的风险增加。目的：我们旨在开发和验证一种实用的预测模型和评分系统，用于识别症状出现后48小时临床恶化风险升高的中高危PE患者。方法：STAMP评分是根据意大利肺栓塞登记处（ClinicalTrials.gov: NCT01604538）登记的450名中高危PE患者的数据制定的，包括通过多变量分析确定的人口统计学、临床和影像学变量。结果：270例患者的衍生队列用于创建评分，随后在180例患者中进行了验证。在衍生队列中，多变量分析确定了5个48小时临床恶化的独立预测因素：年龄≥65岁（1分）、胸痛（1分）、晕厥（2分）、TAPSE/PASP≤0.33（2分）和平均动脉压(MAP)≤81.5 mmHg（2分）。根据总分，将患者分为低概率组（0-2分）、中概率组（3-5分）和高概率组（6-8分），不同类别的事件发生率显著增加(p结论：STAMP评分是一种新颖、简单、准确的工具，可增强中高危PE患者的早期风险分层，提高对48小时临床恶化风险最高患者的识别。

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引用次数: 0

Heart failure with preserved ejection fraction in older inpatients: Where diagnostic algorithms meet geriatric reality 老年住院患者保留射血分数的心力衰竭：诊断算法满足老年现实。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106575

Roberto Presta , Enrico Brunetti , Francesco Palmas , Mario Bo

引用次数: 0

Sex differences in venous thromboembolism outcomes: findings from the GARFIELD-VTE registry 静脉血栓栓塞结局的性别差异：GARFIELD-VTE登记的结果。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106492

Paolo Prandoni , Meg Fluharty , Sebastian Schellong , Henri Bounameaux , Sylvia Haas , Lorenzo G Mantovani , Sherif Sholkamy , Katsuhiro Kondo , Harry Gibbs , Zhi-Cheng Jing , Chern-En Chiang , Peter Verhamme , Alexander GG Turpie , Jeffrey I. Weitz , Walter Ageno , Shinya Goto , Pantep Angchaisuksiri , Karen Pieper , Ajay K Kakkar , GARFIELD-VTE Investigators

Background

The association of sex with clinical outcome risk in venous thromboembolism (VTE) is unclear.

Objective

To investigate sex differences in clinical outcomes and anticoagulation effectiveness in VTE in the GARFIELD-VTE registry.

Methods

Outcomes included all-cause mortality, VTE recurrence, major and any bleeding, myocardial infarction (MI)/acute coronary syndrome (ACS), and stroke/transient ischaemic attack (TIA) over 3 years of follow-up. Hazard ratios were calculated using Cox proportional hazard models with an assessment of sex interactions with parenteral, vitamin K antagonist (VKA), and direct oral anticoagulant (DOAC) therapies.

Results

Of 10,650 patients, 5290 (49.7%) were female and 5360 were male. Females and males had comparable ages (median [Q1-Q3]; females: 60.6 [44.0–72.9] years, males: 60.0 [48.0–70.3] years), body mass index (females: 27.6 [23.6–32.7] kg/m², males: 27.1 [24.4–30.6] kg/m²), and anticoagulant treatment. Females had greater risk of major (adjusted hazard ratio [95% CI (1.25 [1.01–1.55]) and any bleeding (1.32 [1.18–1.47]) than males, but lower risk of recurrent VTE (0.82 [0.72; 0.94]), MI/ACS (0.52 [0.36–0.76]) and stroke/TIA (0.72 [0.52–0.99]). VKA-treated females had greater risk of major (1.69 [1.16–2.48]) and any bleeding (1.43 [1.18–1.73]) than VKA-treated males, while DOAC-treated females had greater risk of any bleeding (1.37 [1.17–1.61]) but not major bleeding (1.22 [0.86–1.72]) than DOAC-treated males. Sensitivity analyses excluding patients with active cancer (N = 9752) yielded similar results.

Conclusions

Compared with males, females with VTE have a greater risk of bleeding, but a lower risk of recurrent VTE, MI/ACS, and stroke/TIA. Sex appears to affect the relationship between VKA and DOAC treatment and bleeding in VTE.

背景：性别与静脉血栓栓塞（VTE）临床结局风险的关系尚不清楚。目的：探讨GARFIELD-VTE患者临床结局和抗凝效果的性别差异。方法：随访3年，包括全因死亡率、静脉血栓栓塞复发、大出血和任何出血、心肌梗死(MI)/急性冠状动脉综合征（ACS）和卒中/短暂性缺血发作（TIA）。使用Cox比例风险模型计算风险比，评估与肠外、维生素K拮抗剂（VKA）和直接口服抗凝剂（DOAC）治疗的性别相互作用。结果：10650例患者中，女性5290例（49.7%），男性5360例。男女年龄（中位数[Q1-Q3]；女性：60.6[44.0-72.9]岁，男性：60.0[48.0-70.3]岁）、体重指数（女性：27.6 [23.6-32.7]kg/m2，男性：27.1 [24.4-30.6]kg/m2）和抗凝治疗相似。女性的主要风险（校正后的危险比[1.25[1.01-1.55]）和任何出血（1.32[1.18-1.47]）高于男性，但静脉血栓栓塞（0.82[0.72;0.94]）、心肌梗死/ACS（0.52[0.36-0.76]）和卒中/TIA（0.72[0.52-0.99]）的复发风险较男性低。vka治疗的女性大出血风险（1.69[1.16-2.48]）和大出血风险（1.43[1.18-1.73]）高于vka治疗的男性，doac治疗的女性大出血风险（1.37[1.17-1.61]）高于doac治疗的男性，但大出血风险（1.22[0.86-1.72]）高于doac治疗的男性。排除活动性癌症患者（N = 9752）的敏感性分析得出了类似的结果。结论：与男性相比，女性静脉血栓栓塞患者的出血风险更高，但静脉血栓栓塞复发、MI/ACS和卒中/TIA的风险较低。性别似乎影响VKA和DOAC治疗与静脉血栓栓塞出血之间的关系。

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引用次数: 0

Prognostic impact of left ventricular dilatation in heart failure with mildly reduced ejection fraction 左心室扩张对心力衰竭伴轻度射血分数降低的预后影响。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106510

Henning Johann Steffen , Michael Behnes , Jonas Dudda , Alexander Schmitt , Noah Abel , Felix Lau , Marielen Reinhardt , Thomas Bertsch , Kathrin Weidner , Daniel Duerschmied , Ibrahim Akin , Tobias Schupp

Objective

This study investigated the prognostic value of left ventricular (LV) dilatation in patients with heart failure with mildly reduced ejection fraction (HFmrEF).

Background

Adverse cardiac remodeling may lead to LV dilatation and impaired prognosis in heart failure with reduced ejection fraction (HFrEF). Its significance in HFmrEF remains unclear.

Methods

Patients hospitalized with HFmrEF (2016–2022) were included and stratified by the presence or absence LV dilatation (males: LV end-diastolic diameter (LVEDD) >58 mm; females: >52 mm). Kaplan–Meier and multivariable Cox regression analyses assessed 30-month all-cause mortality and HF-related rehospitalization.

Results

Among 2154 patients (median LVEDD 49.0 mm), 290 (13.5 %) had LV dilatation. These patients were younger (73 vs. 76 years; p = 0.001), less often males (42.2 % vs. 67.2 %; p = 0.001), and more likely to have non-ischemic cardiomyopathy (10.0 % vs. 6.3 %; p = 0.019). LV dilatation was not associated with 30-month all-cause mortality (29.7 % vs. 31.4 %; HR = 0.933; 95 % CI 0.744–1.171; p = 0.548) but was linked to higher HF-related rehospitalization risk (19.1 % vs. 12.5 %; HR = 1.606; 95 % CI 1.193–2.161; p = 0.003), even after multivariable adjustment (HR = 1.613; 95 % CI 1.163–2.238; p = 0.004).

Conclusion

In HFmrEF, LV dilatation independently predicts HF-related rehospitalization but not all-cause mortality.

目的：探讨左室扩张对心力衰竭伴轻度射血分数降低（HFmrEF）患者的预后价值。背景：不良的心脏重构可导致左室扩张和心力衰竭伴射血分数降低（HFrEF）的预后受损。其在HFmrEF中的意义尚不清楚。方法：纳入住院的HFmrEF患者（2016-2022），并根据是否存在左室扩张进行分层(男性：左室舒张末期直径(LVEDD) >58 mm；雌：>52毫米)。Kaplan-Meier和多变量Cox回归分析评估了30个月的全因死亡率和hf相关的再住院。结果：在2154例患者（中位LVEDD 49.0 mm）中，290例（13.5%）发生左室扩张。这些患者较年轻（73岁对76岁，p = 0.001），男性较少（42.2%对67.2%,p = 0.001），更可能患有非缺血性心肌病（10.0%对6.3%,p = 0.019）。左室扩张与30个月全因死亡率无关（29.7% vs. 31.4%; HR = 0.933; 95% CI 0.744-1.171; p = 0.548），但与hf相关的再住院风险较高相关（19.1% vs. 12.5%; HR = 1.606; 95% CI 1.193-2.161; p = 0.003），即使在多变量调整后也是如此（HR = 1.613; 95% CI 1.163-2.238; p = 0.004）。结论：在HFmrEF中，左室扩张独立预测hf相关的再住院，但不能预测全因死亡率。

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引用次数: 0

Multimodality imaging for cardiac amyloidosis: clinical applications and future directions 心脏淀粉样变性的多模态成像：临床应用及未来发展方向。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106562

G Sinigiani , L De Michieli , S Nistri , D Cecchin , D Mele , A Cipriani

Cardiac amyloidosis (CA) is a progressive and underdiagnosed cause of heart failure, primarily due to transthyretin (ATTR) or immunoglobulin light-chain (AL) amyloid deposition. Non-invasive imaging has transformed the clinical approach to CA by improving early detection, risk stratification, and therapeutic monitoring. This narrative review summarizes the clinical value of multimodality imaging in CA, focusing on the diagnostic and prognostic contributions of echocardiography, cardiac magnetic resonance (CMR), bone scintigraphy, and positron emission tomography (PET). Echocardiography remains the first-line modality for identifying CA “red flags,” including biventricular hypertrophy, diastolic dysfunction, and apical sparing of longitudinal strain. CMR offers superior tissue characterization through late gadolinium enhancement, native T1 and T2 mapping, and extracellular volume quantification (ECV), which correlate with disease severity and response to therapy. ECV can be assessed also by cardiac computed tomography. Bone scintigraphy allows non-invasive diagnosis of ATTR-CA in the absence of monoclonal protein. PET imaging with amyloid-binding tracers is emerging as a promising tool for early detection, quantification and differential diagnosis. Multimodality imaging offers complementary information that is essential for the diagnosis, staging, and longitudinal follow-up of patients with CA. Familiarity with the strengths and limitations of each diagnostic modality is essential to guide their appropriate use in clinical practice—not only for cardiologists, but also for internists, geriatricians, and general practitioners, who frequently manage these patients. Future advancements, including the integration of artificial intelligence, may further enhance the diagnostic and prognostic role of imaging in CA.

心脏淀粉样变性（CA）是一种进行性且未被确诊的心力衰竭原因，主要是由于甲状腺转甲状腺素（ATTR）或免疫球蛋白轻链（AL）淀粉样蛋白沉积。通过改善早期发现、风险分层和治疗监测，非侵入性影像学改变了CA的临床方法。本文综述了多模态成像在CA中的临床价值，重点介绍了超声心动图、心脏磁共振（CMR）、骨显像和正电子发射断层扫描（PET）的诊断和预后贡献。超声心动图仍然是识别CA“危险信号”的一线方法，包括双室肥厚、舒张功能障碍和纵向应变的根尖保留。CMR通过晚期钆增强、原生T1和T2定位以及与疾病严重程度和治疗反应相关的细胞外体积量化（ECV）提供了优越的组织表征。ECV也可以通过心脏计算机断层扫描来评估。骨显像可以在缺乏单克隆蛋白的情况下对atr - ca进行无创诊断。淀粉样蛋白结合示踪剂的PET成像正在成为早期检测、定量和鉴别诊断的一种有前途的工具。多模式成像为CA患者的诊断、分期和纵向随访提供了必要的补充信息。熟悉每种诊断模式的优势和局限性对于指导临床实践中的适当使用至关重要，不仅对心脏病专家，而且对经常管理这些患者的内科医生、老年医生和全科医生都是如此。未来的进展，包括人工智能的整合，可能会进一步增强成像在CA中的诊断和预后作用。

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引用次数: 0

Frailty measurement in research and clinical practice: An updated review 研究和临床实践中的虚弱测量：最新综述。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106595

Elsa Dent , Peter Hanlon , Paul Kowal , Emiel O. Hoogendijk

Frailty is a highly prevalent geriatric condition, affecting between 12–24% of older adults globally. It remains a major cause of morbidity and mortality in older adults. Incorporating frailty measurement into clinical decision making can guide optimal patient care. This updated review presents an outline of current frailty definitions and measurement approaches in both research and clinical practice, including: Fried’s frailty phenotype; Rockwood and Mitnitski’s Frailty Index (FI) of cumulative deficits; Clinical Frailty Scale (CFS); Fatigue, Resistance, Ambulation, Illness and Loss of weight (FRAIL) scale; Edmonton Frail Scale (EFS); electronic Frailty Index (eFI); Hospital Frailty Risk Score (HFRS); Study of Osteoporotic Fractures (SOF) Index; Tilburg Frailty Indicator (TFI); Groningen Frailty Indictor (GFI); Multidimensional Prognostic Index (MPI); the Kihon Checklist (KCL); Geriatric 8 (G8) for oncology; the Essential Frailty Toolset (EFT) for cardiology; plus gait speed and grip strength. The main strengths and limitations of existing frailty measurements are summarised, including how well these measurements operationalise frailty in terms of their accuracy in identifying frailty, their basis on biological causative theory, and their ability to reliably predict patient outcomes and response to potential therapies.

虚弱是一种非常普遍的老年疾病，影响到全球12-24%的老年人。它仍然是老年人发病和死亡的一个主要原因。将虚弱测量纳入临床决策可以指导最佳的患者护理。这篇最新的综述概述了目前研究和临床实践中虚弱的定义和测量方法，包括：弗里德的虚弱表型；累积赤字的Rockwood和Mitnitski脆弱性指数（FI）；临床虚弱量表；疲劳、抵抗、行走、疾病和体重下降（虚弱）；埃德蒙顿虚弱量表；电子脆弱指数（eFI）；医院衰弱风险评分；骨质疏松性骨折（SOF）指数的研究蒂尔堡虚弱指数；格罗宁根衰弱指数（GFI）；多维预后指数；基洪检查表（KCL）；老年8 （G8）用于肿瘤学；心脏病学基本衰弱工具集（EFT）；加上步态速度和握力。总结了现有虚弱测量的主要优势和局限性，包括这些测量在识别虚弱方面的准确性，它们基于生物学因果理论，以及它们可靠预测患者结果和对潜在治疗反应的能力方面对虚弱的操作效果。

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引用次数: 0

Corrigendum to “Natural history of the severe subtype of MYH9-related disease (Epstein syndrome)” [European Journal of Internal Medicine 138 (2025) 6354] “myh9相关疾病（爱泼斯坦综合征）严重亚型的自然史”[欧洲内科学杂志138(2025)6354]的勘误表。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106623

Kazuma Shinno , Shinji Kunishima , Atsushi Sakamoto , Toru Uchiyama , Akira Ishiguro

引用次数: 0

The widening gap between point-of-care ultrasonography course participation and supervision resources 护理点超声课程参与与监督资源之间的差距日益扩大。

IF 6.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1016/j.ejim.2025.106645

Antonio Leidi , Aurélie Zacharias-Fontanet , Olivier Grosgurin

引用次数: 0

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