Jara-Palomares L, Bikdeli B, Jiménez D
… +14 more, Muriel A, Yamashita Y, Carrier M, Mahé I, Moustafa F, Fernández-Reyes JL, Gorostidi-Pérez J, de la Roca Toda M, Verhamme P, Barca-Hernando M, González-Acosta M, Andrade-Ruiz HA, Monreal M, RIETE Investigators
Eur J Intern Med
· 2026 May · PMID 42185149
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BACKGROUND: Routine cancer screening is not recommended after venous thromboembolism (VTE), but improved risk stratification may support tailored strategies. METHODS: We conducted a prospective, multicentre cohort study...BACKGROUND: Routine cancer screening is not recommended after venous thromboembolism (VTE), but improved risk stratification may support tailored strategies. METHODS: We conducted a prospective, multicentre cohort study (2001-2023) including 48,595 patients from the RIETE registry (207 centres, 31 countries). Patients were allocated to derivation (n = 24,670) and internal validation (n = 10,572) cohorts. External validation (n = 4042) included patients from the COMMAND-VTE-II registry and the SOME trial. The primary outcome was cancer diagnosis within 12 months after VTE. Model performance was assessed using discrimination (AUC), calibration, Brier score, and positive predictive value (PPV). RESULTS: Cancer was diagnosed in 1158 patients (3.29%, 95%CI: 3.10-3.48%) within 12-months after VTE. Predictors included male sex, age ≥70 years, chronic lung disease, anemia, platelet count >350 × 10⁹/L, and clinically relevant bleeding occurring during follow-up. The model showed an AUC of 0.63, 0.63 and 0.60 in the derivation, internal validation and external validation cohort, respectively. High-risk classification occurred in 38.4% and 46.7% of patients in the derivation and external validation cohort. The positive predictive value for cancer diagnosis within 1 year was 4.9% (95% CI 4.5-5.3%) in the derivation cohort and 3.3% (95% CI 2.6-4.2%) in the external validation cohort. A nomogram was developed to facilitate individualized risk estimation. CONCLUSIONS: We derived and externally validated a simple clinical score to stratify the risk of cancer diagnosis within one year after VTE. Although its discriminative performance was modest its high negative predictive value may help identify patients at lower probability of occult cancer and support risk-adapted follow-up strategies.
Komici K, Rengo G, Femminella GD
… +7 more, Pagliaro R, D'Onghia ML, Fasciano L, Santulli G, Mone P, Bianco A, Guerra G
Eur J Intern Med
· 2026 May · PMID 42177153
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BACKGROUND: Exercise-induced hypertension (EIH) is recognized as an independent cardiovascular risk factor. Epicardial fat thickness (EFT) has been implicated in various cardiovascular pathologies. However, the relations...BACKGROUND: Exercise-induced hypertension (EIH) is recognized as an independent cardiovascular risk factor. Epicardial fat thickness (EFT) has been implicated in various cardiovascular pathologies. However, the relationship between EFT, EIH, and ventricular arrhythmias remains poorly characterized. This study aimed to investigate the predictive value of EFT for both EIH and premature ventricular beats (PVB). METHODS: A total of 2658 participants were initially screened for eligibility, and normotensive participants of age > 18 were considered for enrollment. All participants underwent a comprehensive clinical evaluation. Data were analyzed considering EIH and PVB. Multivariable logistic regression, ROC and decision curve analysis (DCA) were performed to evaluate the clinical utility of predictive models with and without EFT parameters. RESULTS: ROC curve analysis demonstrated that EFT had moderate ability for predicting EIH (AUC 0.73, 95% CI 0.69-0.78). Multivariable logistic regression revealed that EFT was independently associated with EIH (OR 2.27, 95% CI 1.72-2.98). For the prediction of PVB among individuals with EIH, EFT demonstrated good accuracy (AUC 0.78, 95% CI 0.69-0.86). Among patients with EIH, epicardial fat was strongly associated with increased odds of arrhythmias (OR 3.58, 95% CI 2.35-5.46, p < 0.001). DCA revealed that incorporating EFT scores into predictive models provided superior net benefit improving the clinical utility of the predictive model. CONCLUSIONS: EFT is an independent predictor of both exercise-induced hypertension and ventricular arrhythmias, with strong predictive value for premature ventricular beats in patients with EIH. The incorporation of EFT into risk prediction models provides superior clinical net benefit compared to traditional risk factors alone.
Giorgi J, Chamay S, Fischer-Bacca CO
… +9 more, Dandamudi M, de Lucena LA, Cavalcante D, Samiego MA, Mojica JC, Batista PG, Barbagelata A, Mentz RJ, Fudim M
Eur J Intern Med
· 2026 May · PMID 42177151
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BACKGROUND: Cardiorenal dysfunction is a major contributor to morbidity, rehospitalization, and mortality in advanced heart failure (HF) and cardiogenic shock. Traditional decongestive approaches-loop diuretics, combinat...BACKGROUND: Cardiorenal dysfunction is a major contributor to morbidity, rehospitalization, and mortality in advanced heart failure (HF) and cardiogenic shock. Traditional decongestive approaches-loop diuretics, combination natriuretics, and ultrafiltration-are frequently inadequate in the setting of diuretic resistance or persistent venous and interstitial congestion, underscoring a substantial therapeutic gap. CONTENT: Novel device-based therapies have emerged to address the hemodynamic mechanisms underlying cardiorenal syndrome (CRS). These technologies can be categorized into five mechanistic families: (1) Pushers, which augment forward aortic flow to improve renal arterial perfusion; (2) Pullers, which selectively reduce renal venous hypertension; (3) Fluid Shifters, which mobilize interstitial fluid through lymphatic or peritoneal pathways; (4) Automated Diuresis Systems, which maintain euvolemia and optimize natriuresis during intensive loop diuresis; and (5) Splanchnic Nerve Ablation/Modulation, which increases venous capacitance and lowers cardiac filling pressures. Early feasibility studies report improvements in hemodynamics, enhanced natriuresis, reductions in filling pressures, and stabilization of renal function, reinforcing the physiologic rationale central to CRS management. GAPS AND FUTURE DIRECTIONS: Despite encouraging early results, substantial uncertainties remain. Criteria for patient selection, standardized trial endpoints, integration with guideline-directed therapy, and long-term renal and cardiovascular outcomes are not yet established. Small sample sizes, short follow-up durations, and a lack of randomized comparative trials limit existing evidence. CONCLUSION: Device-based therapies represent a shift from symptomatic fluid removal toward targeted, mechanism-driven decongestion in advanced HF and CRS. Future phenotype-guided, rigorously designed randomized trials are essential to determine whether these technologies can meaningfully modify renal trajectory, reduce hospitalization burden, and improve survival in this high-risk population.
Madonna R, Marra AM, Biondi F
… +14 more, Carbone A, Carluccio E, Codullo V, D'Alto M, D'Agostino A, De Luca M, Esposito AM, Ferrara F, Ghio S, Franzese M, Zanfardino M, Naeije R, De Caterina R, Bossone E
Eur J Intern Med
· 2026 May · PMID 42151027
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BACKGROUND: Asymptomatic patients with Human Immunodeficiency Virus (HIV) infection may remain at increased risk for pulmonary vascular disease. We therefore explored the pulmonary circulation in these patients using exe...BACKGROUND: Asymptomatic patients with Human Immunodeficiency Virus (HIV) infection may remain at increased risk for pulmonary vascular disease. We therefore explored the pulmonary circulation in these patients using exercise stress echocardiography. METHODS: One hundred and fifty subjects from the RIGHT-NET registry were studied with exercise echocardiography: 37 with HIV infection and no overt pulmonary hypertension (PH), 48 with connective tissue disease (CTD) as disease-related latent PH controls, and 65 healthy controls. CTD and healthy controls were matched to HIV patients using propensity score matching based on age and sex. Exercise echocardiography followed standard protocols, with derived assessments of mean pulmonary arterial pressure (mPAP), cardiac output (CO), and mPAP/CO slopes. RESULTS: During exercise, the HIV and CTD patients reached higher mPAP than healthy controls (35.2±5.9 and 30±4±7.7 mmHg vs 24.4±7.3 mmHg respectively, p<0.01). The mPAP/CO slope was abnormal (>3 mmHg/L/min) in 32.4% of HIV, 45.8% of CTD, and only 12.3% of healthy subjects. Tricuspid annular plane systolic excursion (TAPSE) and its ratio to systolic PAP were not different between the three study groups at resting. No associations were found between mPAP/CO slope or echocardiographic indices of right or left ventricular function and HIV viral load, CD4+ count, or antiretroviral therapy duration. CONCLUSIONS: We conclude that exercise stress echocardiography of the pulmonary circulation in asymptomatic HIV infection may commonly be associated with a latent PH, as in asymptomatic CTD.
Dardi F, Donato F, Cennerazzo F
… +10 more, Niro F, Ballerini A, Guarino D, Russo V, Bertozzi R, Nardi E, Manes A, Palazzini M, Lovato L, Galiè N
Eur J Intern Med
· 2026 May · PMID 42140816
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BACKGROUND: Pulmonary artery (PA) dilation is common in pulmonary arterial hypertension (PAH), yet its prognostic role and haemodynamic determinants remain poorly defined. We aimed to assess the prognostic significance o...BACKGROUND: Pulmonary artery (PA) dilation is common in pulmonary arterial hypertension (PAH), yet its prognostic role and haemodynamic determinants remain poorly defined. We aimed to assess the prognostic significance of PA dimension for all-cause mortality and sudden death (SD), and to identify haemodynamic determinants of PA size and its longitudinal changes. METHODS AND RESULTS: In this retrospective observational study, we included consecutive PAH patients who underwent baseline (n = 754) and follow-up (n = 333) computed tomography pulmonary angiography and right heart catheterisation. PA diameter, haemodynamic, and clinical data were collected. The primary outcome was all-cause mortality; the secondary outcome was the risk of SD. PA diameter was not an independent predictor of all-cause mortality; however, a value ≥40 mm independently predicted SD [sHR 3.93 (1.86-8.30), p < 0.001]. Mean pulmonary arterial pressure (mPAP) was independently associated with PA size and its progression over time. Specifically, a reduction in mPAP ≥12 mmHg or achieving mPAP ≤35 mmHg was associated with attenuated PA enlargement. The incidence of SD declined over the study period; this temporal trend coincided with increased recognition and screening for left main coronary artery (LMCA) compression, although a definite causal relationship cannot be inferred. CONCLUSION: In PAH, PA dilation ≥40 mm predicts SD but not all-cause mortality. mPAP is associated with both baseline PA size and its progression. Whether aggressive haemodynamic optimisation and early identification of LMCA compression can prevent SD requires prospective validation.