European Journal of Internal Medicine最新文献

英文中文

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

Monitoring time-to-detection of recurrent atrial fibrillation in patients with transient new-onset atrial fibrillation detected initially during hospitalization for noncardiac surgery or medical illness 非心脏手术或内科疾病住院期间首次发现的一过性新发心房颤动患者复发性心房颤动的监测时间

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.2025.106515

William F. McIntyre , Linda S. Johnson , Alexander P. Benz , Maria E. Vadakken , Nicole R. Latendresse , Chinthanie Ramasundarahettige , Faith Kirabo , Jorge A. Wong , Jason D. Roberts , Jeff S. Healey

Background

Approximately one-third-of patients with transient new-onset atrial fibrillation (AF) during hospitalization for noncardiac surgery or medical illness will have recurrent AF within 1 year when assessed using two 14-day ECG monitors. The proportion of patients that would be diagnosed with recurrent AF with less monitoring is unknown.

Methods

We used data from a prospective cohort of participants with transient new-onset AF while hospitalized for noncardiac surgery or medical illness, who wore one or two 14-day ECG monitors. We calculated the proportion of patients that would be diagnosed with recurrent AF with different durations of ECG monitoring and the median time-to-detection of recurrent AF lasting ≥30 s.

Results

A total of 139 participants (41.0 % female, median CHA₂DS₂-VASc 3) wore an ECG monitor a median of 1.5 months following hospital discharge; 83 (59.7 %) wore a second monitor at median of 5.8 months after the first monitor. Recurrent AF was detected in 5.0 % of participants by 1 day, 5.8 % by 2 days, 6.5 % by 3 days, 12.2 % by 7 days, 21.6 % by 14 days and in 28.8 % by the end of the second 14-day monitor. Median monitoring time to recurrent AF was 5.3 (IQR 1.4–9.7) days.

Conclusions

In patients with transient new-onset AF during hospitalization for another reason, the rate of detection of recurrent AF increased with longer monitoring durations. Approximately 80 % of diagnoses were made after 2 days of monitoring; the likelihood of capturing recurrent AF was 4 times higher with 14 days of monitoring compared to 2 days.

背景：大约三分之一因非心脏手术或内科疾病住院的短暂性新发房颤（AF）患者在使用两次14天心电图监测时，会在1年内复发房颤。在监测较少的情况下被诊断为复发性房颤的患者比例尚不清楚。方法：我们使用了一项前瞻性队列研究的数据，参与者在非心脏手术或内科疾病住院期间患有一过性新发房颤，他们佩戴了一个或两个14天的心电图监护仪。我们计算了不同ECG监测时间下被诊断为复发性房颤的患者比例，以及复发性房颤的中位检测时间≥30 s。结果：共有139名参与者（41.0%为女性，CHA2DS2-VASc中位数为3）在出院后1.5个月佩戴心电监护仪；83例（59.7%）患者在第一次监测后中位时间为5.8个月时再次佩戴监护仪。第1天检测到复发性房颤的参与者为5.0%，第2天为5.8%，第3天为6.5%，第7天为12.2%，第14天为21.6%，第二次14天监测结束时为28.8%。复发房颤的中位监测时间为5.3天（IQR 1.4-9.7）。结论：在住院期间因其他原因发生一过性新发房颤的患者中，随着监测时间的延长，房颤复发的检出率增加。大约80%的诊断是在监测2天后做出的；监测14天后再次发生房颤的可能性是监测2天后的4倍。

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引用次数: 0

Cognitive impairment and vascular injury in familial hypercholesterolemia: Looking beyond the association 家族性高胆固醇血症的认知障碍和血管损伤：超越相关性。

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.2025.106571

Wei Cui, Yiguo Chen, Zedong Cheng

引用次数: 0

Methodological considerations for interpreting the association between central systolic blood pressure and brain health 解释中枢收缩压与脑健康之间关系的方法学考虑。

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.2025.106582

Hui Chen

引用次数: 0

Antibiotic use in hospitalized older adults according to WHO AWaRe classification: data from the REPOSI register 根据WHO AWaRe分类住院老年人抗生素使用情况：来自REPOSI登记册的数据。

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.2025.106551

Chiara Elli, Chiara Crippa, Luca Pasina, REPOSI, Investigators

引用次数: 0

Why we measure frailty: Aligning tools with use 我们为什么测量脆弱性：将工具与使用结合起来。

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.2025.106656

Daniele Giuli , Alessandra Ruspi , Graziano Onder

引用次数: 0

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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European Journal of Internal Medicine

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