European Journal of Internal Medicine最新文献

Background: Different electrocardiographic (ECG) criteria were proposed to improve ECG-based detection of left ventricular hypertrophy (LVH), but external validation data are limited and their diagnostic performances in different conditions leading to LVH are not extensively assessed.

Aim: to assess the robustness and limitations of ECG scores across distinct LVH phenotypes.

Methods: The LVH-MORE registry included 408 patients across four cohorts: HTN (n = 103), HCM (n = 104), sAS (n = 101), and controls (n = 100). LVH was defined by echocardiographic left ventricular mass index (LVMi) >115 g/m2 in male subjects and >95 g/m2 in female subjects. Ten ECG criteria were calculated, including Peguero-Lo Presti, Sokolow-Lyon, Cornell, Perugia, Romhilt-Estes, and others. Diagnostic performance was assessed using ROC curves (AUC), sensitivity (Sn), specificity (Sp).

Results: In the HTN cohort, Peguero-Lo Presti achieved the highest AUC for LVH detection (0.752 [95% CI: 0.616-0.888]), with Sn = 31% and Sp = 94%. Other scores showed similar or lower AUCs, with Perugia score showing higher sensitivity (54%). The highest specificity were reached by Sokolow-Lyon and Gubner-Ungerleider (100%). In the HCM cohort, all ECG scores showed modest diagnostic performance (AUC 0.529-0.628). The Perugia and Romhilt-Estes scores achieved the highest sensitivities (94% and 71%, respectively), whereas Sokolow-Lyon showed the highest specificity (90%). In the sAS cohort, AUCs ranged from 0.519 to 0.671. Sensitivity was higher for Perugia (66%) and Romhilt-Estes ≥4 (57%). Highest specificity was shown by Gubner-Ungerleider (95%).

Conclusions: No single ECG criterion provided consistent diagnostic accuracy across different causes of LVH. Voltage-only ECG scores performed better in HTN patients while multi-parametric scores showed relatively better performance in HCM and sAS.

Background: Chronic kidney disease (CKD) commonly coexists with heart failure (HF), negatively impacting prognosis. We analyzed temporal trends in clinical characteristics, HF medications use and outcomes in outpatients with chronic HF and CKD, KDIGO stage 3b and stages 4-5, in a nationwide HF registry.

Methods: We retrospectively analyzed patients stratified by CKD levels (3b: eGFR 30-44; 4-5: eGFR <30 ml/min/1.73 m²) and enrolment period (2007-2016 vs 2017-2023) Outcomes were major adverse cardiovascular (CV) events (MACE) and CV death or heart failure hospitalization (CVd-HFH).

Results: Among 2003 patients, 1450 (72.4%) had stage 3b and 553 (27.6%) stage 4-5 CKD. HF drugs prescription rates were 73.7% for renin-angiotensin system inhibitors/angiotensin receptor-neprilysin inhibitors (RASI/ARNI) (79.3% vs 59%, p<0.001), 52.7% for mineralocorticoid receptor antagonist (MRA) (56.4% vs 43%, p<0.001), 81.5% for betablockers (BB) (81.6% vs 81.4%, p=0.949), respectively. Over time, use and target-dose achievement of RASI/ARNI declined, while BB and MRA uptake increased. Among HFrEF patients 47% (stage 3b) and 31% (stage 4-5) received triple therapy (RASI/ARNI+BB+MRA). Stage 4-5 patients had a higher risk of MACE (adjHR 1.280, 95%CI 1.078-1.519, p=0.005) Outcomes did not improve over time (CKD stage*enrolment period interaction, p=0.277).

Conclusions: In HF outpatients with moderate-to-severe CKD, we observed higher contemporary use of BB, MRA, and triple therapy than previously reported. Prognosis did not substantially improve over time, likely due to increasing patient complexity. Integrated cardio-renal care and prospective studies to optimize treatment and improve outcomes in this population are needed.

Background: Recent guidelines emphasize a healthy diet as a key element in secondary cardiovascular prevention.

Methods: This study included 1002 patients with cardiovascular disease from the CORDIOPREV Study (NCT00924937). Participants were randomized to follow a Mediterranean or low-fat diet for 7 years. We assessed whether the degree of dietary adherence, measured by the 14-point Mediterranean Diet Adherence Screener (MEDAS) and a 9-point low-fat diet adherence questionnaire, influenced the incidence of major cardiovascular events (MACE) in each diet and whether any diet proved superior when excluding the least adherent patients.

Findings: MACE incidence significantly decreased with higher adherence in both diet groups (log-rank p < 10⁻⁶). Indeed, in the Mediterranean Diet group (n = 502), MACE rates were 44.44 %, 25.49 %, 20 %, 14.77 %, 11.59 % and 10.81 % in patients achieving a MEDAS score of <9, 9, 10, 11, 12 and >12, respectively. Similarly, in the low-fat diet group (n = 500), MACE rates were 37 %, 35.4 %, 32.2 %, 18.5 %, 17.4 % and 9.1 % in patients achieving an adherence score of <4, 4, 5, 6, 7 and >7, respectively. The multivariate-adjusted hazard ratios (HR) for the highest versus lowest adherence categories ranged from 0.142 to 0.148 for the Mediterranean Diet and 0.127 to 0.142 for the low-fat diet.

Interpretation: Adherence to both dietary patterns was inversely associated with MACE recurrence over 7 years, with reductions of up to 30-35 %. High adherence to either the Mediterranean or the low-fat diet was associated with significant reductions in cardiovascular risk compared to the lowest adherence categories within each group.

Funding: Fundacion Patrimonio Comunal Olivarero; Fundacion Centro para la Excelencia en Investigacion sobre Aceite de Oliva y Salud; local, regional, and national Spanish Governments; European Union.

Cordioprev trial registration number: ClinicalTrials.gov, NCT00924937.

Background: Identifying early pathobiological mechanisms associated with the onset and progression of heart failure (HF) could guide development of preventive strategies.

Objective: To elucidate molecular pathways driving HF pathogenesis and identify potential therapeutic targets by profiling plasma microRNAs (miRNAs).

Methods: Multicenter study including 799 elderly patients from HOMAGE. Incident HF was defined as the first hospitalization for HF. A panel of miRNAs implicated in HF was analyzed using RT-qPCR. Two machine learning-based feature selection methods were employed to identify contributors for HF onset. Associations between miRNA targets and HF were explored using publicly available datasets. Bioinformatic analyses were performed using the intersected targets, including functional and single-cell enrichment analyses and drug-gene interaction assessment.

Results: After adjusting for confounders, four miRNAs (miR-21-5p, miR-24-3p, miR-132-3p, miR-221-3p) were significantly associated with incident HF in univariate analyses (FDR < 0.05). The feature selection process identified miR-21-5p, miR-24-3p and miR-221-3p as the most informative miRNAs linked to HF onset. The predicted targetome of these miRNAs encompassed 1293 transcripts, of which 32 demonstrated cardiac expression and differential levels between HF cases and controls across six different datasets. Pathway enrichment analysis revealed five key biological processes associated with HF progression: i) calcium homeostasis and signaling; ii) cell proliferation; iii) stress response and remodeling; iv) metabolic dysregulation; and v) neurohormonal activation. Drug-gene interaction analysis identified five FDA-approved agonists of the target GABBR2.

Conclusions: The identified miRNAs provide a rationale for future longitudinal and mechanistic studies and potentially inform the development of novel strategies for HF prevention.