May 2026
39 ArticlesClinical Insights
It’s time to improve antithrombotic therapy! A global perspective for antithrombotic stewardship
Antithrombotic stewardship (ATS) is a practical, evidence-based care model slowly gaining traction across the globe [1,2]. The impetus for this trend is the persistent evidence for low-quality... more
Intrinsic capacity in older adults: A concise guide for non-geriatricians
Over the past decades, there has been a radical and profound change in the population structure, characterised by a gradual increase in the prevalence of individuals in older age groups and a... more
Commentary
Lungs and heart in COPD exacerbations: it takes two to tango
The lungs and the heart are inseparably linked anatomically, physiologically, and functionally in their shared task of delivering oxygen to the body and removing the carbon dioxide generated by... more
Left atrial appendage closure for atrial fibrillation stroke prevention in hereditary hemorrhagic telangiectasia is effective and safe with simplified, time-limited antithrombotic therapy
In this issue of the European Journal of Internal Medicine, Torres-Iglesias and colleagues present an observational study of 23 patients with hereditary hemorrhagic telangiectasia (HHT) and atrial... more
The critical role of dietary adherence in secondary cardiovascular prevention: Beyond the nutrient composition
The management of patients with established coronary heart disease (CHD) has traditionally focused on pharmacological interventions and revascularization procedures. However, lifestyle modifications... more
Can heart failure be detected before it occurs? Insights from circulating microRNAs
Heart failure (HF) remains one of the most complex and heterogeneous syndromes in healthcare systems, where multiple biological processes converge long before the onset of symptoms. Despite... more
Ideas and Opinions
Hospitalist co-management in multimorbid medical and surgical patients: Insights from the United States and Europe
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Internal Medicine Flashcard
Tongue atrophy following unexplained nausea, vomiting, and hiccups
A 45-year-old woman was admitted with aspiration pneumonia. She was found to have progressive dysphagia and severe dysarthria. Neurological examination showed a hypernasal voice, diminished gag... more
“Normally distended” bladder in an anuric hemodialysis patient
A 72-year-old man with end-stage kidney disease had been on maintenance hemodialysis for 18 years and was completely anuric. He presented with a two-week history of persistent low-grade fever (37 °C... more
Letter to the Editor
Right ventricular-pulmonary circulation uncoupling in older patients with acute HFpEF: is TAPSE/PASP ratio a dichotomous or continuous prognostic marker?
We appreciated Pagnoni et al insightful comments [1] on our study as they raise important physiopathological and clinical questions that might further increase our understanding of right ventricular-... more
Beyond acute severity: Age as a determinant of in-hospital mortality in acute respiratory failure requiring non-invasive respiratory support in an intermediate care unit
The increasing burden of acute illness, together with the progressive reduction in hospital bed capacity across Europe, has intensified the need for optimized management strategies for high-acuity... more
Optimizing cardiorenal protection in HFrEF: from pharmacological mechanisms to clinical implementation. Author's reply
We thank Dr. Yuan and coll. [1] for their interest in our review, Renal protection in heart failure with reduced ejection fraction: not all that glitters is gold [2], and for their comments on the... more
Refining the impact of epicardial adipose tissue assessment
We read with great interest the correspondence by Momot et al. [1], which offers a thoughtful and constructive commentary on our recent narrative review exploring the role of epicardial fat... more
Residual respiratory events and daytime sleepiness despite management of obstructive sleep apnoea with and without additional central apnoeas. A three-month follow-up study. Authors’ reply
We thank Fan Yuan, and coll [1] and Linru Zhong and coll [2] for their interest in our study [3]. They add pertinent reflections and critical analysis of our study. We are aware of the unavoidable... more
Microvascular angina: it’s time to move beyond fixed paradigms
Dear Editor,
Management of ANOCA and suspected microvascular angina: integration of plaque-directed and functional strategies
We read with interest the Ideas and Opinions article by De Servi and colleagues, who question the current emphasis on invasive coronary function testing (CFT) in patients with angina with no... more
Reconsidering residual sleepiness and respiratory events in treated obstructive sleep apnea
We read with great interest the article by Vitacca and colleagues regarding the persistence of respiratory events and daytime sleepiness in patients treated for obstructive sleep apnea [1]. The study... more
TAPSE/PASP ratio in older HFpEF patients: Prognostic insights and geriatric challenges
We read with interest the article by De Matteis et al. on the prognostic role of the TAPSE/PASP ratio in older patients with HFpEF hospitalized for acute heart failure [1]. The authors show that RV-... more
Epicardial adipose tissue assessment for earlier cardiovascular risk prediction: from association to clinical utility
Calcaterra and colleagues provide a timely narrative review on epicardial adipose tissue (EAT) as an imaging marker of cardiometabolic risk and a potentially modifiable therapeutic target [1]. Yet... more
Optimizing cardiorenal protection in HFrEF: From pharmacological mechanisms to clinical implementation
We read with great interest the review article by Russo et al. titled [1]. The authors provided a comprehensive and timely overview of the "four pillars" of heart failure therapy—RAAS inhibitors,... more
SGLT2 Inhibitors in musculoskeletal and connective tissue diseases: Is there a role?
Dear Editor,
Most acute heart failure with preserved ejection fraction is not true HFpEF
Dear Editor,
Heart failure with preserved ejection fraction in the elderly: Clinical, imaging, and biomarker profiles according to global longitudinal strain by cardiac magnetic resonance
Dear editor,
The four ages of diagnosis: A physician’s journey through time
Dear Editor
Beyond ejection fraction: Small left ventricular volumes define a high-risk phenotype in acute heart failure with preserved ejection fraction
In patients with heart failure and reduced ejection fraction (HFrEF), larger indexed left ventricular volumes (iLVEDV) have been traditionally considered a surrogate of lower left ventricular... more
Communicating robustness and sex-specific benefit of SGLT2 inhibitors in HFpEF and HFmrEF
Dear Editor,
Integrating sTREM2 into non-invasive pathways for early MASH in MASLD
We read with great interest the article by Mahmoudian et al., who evaluated soluble triggering receptor expressed on myeloid cells 2 (sTREM2) as a non-invasive biomarker for early metabolic... more
Original Article
Guideline-directed medical therapy and mortality in heart failure patients hospitalized for COPD exacerbation
Heart failure (HF) is highly prevalent (≥ 15-20%) among patients with chronic obstructive pulmonary disease (COPD) and associated with increased mortality [1,2]. In addition, approximately 20% of HF... more
From hospital to home: Practical guidance when caring for patients with COPD and heart disease
Patients with chronic obstructive pulmonary disease (COPD) frequently suffer from other chronic conditions, with cardiovascular disease being especially common. The presence of cardiovascular disease... more
Efficacy and harms of polypills for cardiovascular disease prevention: A systematic review and meta-analysis of randomized controlled trials
To systematically evaluate polypill effects on cardiovascular (CV) risk factors, CV outcomes, and adverse events in CV disease (CVD) prevention populations.
Direct oral anticoagulants versus Vitamin K antagonist in kidney transplant recipients with atrial fibrillation: A study from a global federated research network
The risk-benefit profile of direct oral anticoagulants (DOACs) in kidney transplant recipients (KTRs) with atrial fibrillation (AF) remains under-investigated.
Identifying distinct clinical phenotypes and outcomes in adult-onset IgA vasculitis using unsupervised clustering analysis
IgA vasculitis (IgAV) is a systemic vasculitis of the small vessels characterized by immune complexes including immunoglobulin A1 (IgA1) [1]. The clinical picture is a vascular purpura with or... more
Incidence of major adverse cardiovascular events decreases with greater adherence to both Mediterranean and low-fat dietary patterns in secondary prevention patients: a randomized controlled trial
Diet plays a crucial role in lifestyle interventions for secondary cardiovascular prevention [1–5]. Recent guidelines for reducing cardiovascular risk in secondary prevention populations recommend,... more
Mechanistic insights into heart failure progression and therapeutic target discovery through plasma microRNA profiling: Findings from HOMAGE
Identifying early pathobiological mechanisms associated with the onset and progression of heart failure (HF) could guide development of preventive strategies.
Left atrial appendage closure in patients with hereditary hemorrhagic telangiectasia and atrial fibrillation: a prospective study and systematic review
Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disease with a high risk of iron deficiency anemia secondary to epistaxis and gastrointestinal bleeding. Atrial... more
Review Article
Discontinuation of incretin-based therapies in obesity: the complexity of a breakup
Incretin-based therapies, including mono-, dual-, and emerging triple-agonists, have transformed the pharmacological management of obesity by inducing substantial and sustained weight loss together... more
Pitfalls of autoimmune serological markers and practical diagnostic workflows in connective tissue diseases and rheumatoid arthritis
Laboratory markers represent a highly valuable tool to support the diagnosis of systemic autoimmune diseases. However, their correct interpretation is essential to avoid misdiagnoses, with particular... more
Chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidities: Shedding light on key interactions and therapeutic approaches
Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular disease and the both conditions share common risk factors (smoke), associated pathophysiological mechanisms (... more
Detecting dementia symptoms in internal medicine settings: clinical red flags, frailty and intervention perspectives
This paper provides a comprehensive overview of dementia in internal medicine hospital settings, highlighting its clinical detection, key red flags and frailty factors, as well as intervention... more