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Introduction - Dilated cardiomyopathy (DCM) represents a group of myocardial disorders associated with mechanical and electrical dysfunctions that causes enlargement of both ventricles. Over 50% of primary DCM are familial in nature and the rest have genetic etiology. Secondary DCM may occur during a wide range of diseases. Functionally, DCM is characterized by systolic dysfunction leading finally to a diminished left ventricular ejection fraction. A good correlation has been found between the severity of the condition clinically and the extent and degree of microscopic abnormalities. Methods - The macroscopic features can be best appreciated with a four-chamber view of the heart or by the short axis (bread loafing) slicing technique. Myocardial fragments are harvested, trimmed and kept in fixation solution for minimum 24 hours necessary for microscopic examination. Subsequently, specimens undergoes tissue processing. Results - Gross examination reveals increased heart weight with a globular shape and a decreased tonus. Endocardial fibrous thickening starts over the septal portion of the LV where there is a prominent fine reticulation of trabecular muscles. At microscopic level, different degrees of myofibrillar hypertrophy (enlarged, irregularly shaped muscle fibers with hyperchromatic, squared off nuclei) and collagenous fibrosis are detected. Discussions - Familial DCM is proposed to be considered as a form of "cytoskeltopathy". Interstitial fibrosis contributes to ventricular dysfunction and affects prognosis in patients with DCM. Conclusions - Without cardio-pulmonary transplant, patients with DCM has ominous prognosis with greatly reduced 5-year survival. The most common histologic alteration in DCM patients is the onset of perivascular fibrosis and proliferation of collagen fibers. [ABSTRACT FROM AUTHOR]

Introduction - Heart failure (HF) and atrial fibrillation (AF) coincide in many patients. The bond between these two conditions is sealed by the shared similar risk factors and common pathophysiology. Purpose - The objective of our study is to assess the prevalence, clinical characteristics and to determine in-hospital mortality of non-valvular AF in HF patients. Methods: A total of 434 patients admitted consecutively in our clinic with diagnosis of AF and HF were evaluated during hospitalization. Baseline characteristics and clinical outcomes were extracted. The patients were divided in two gropus: valvular and non-valvular AF. Results - The mean age of our studied group (263 eligible patients with nonvalvular AF and HF) was 73.79 years with a SD of 10.487 (p=0.000). Comorbidities found among our patients were: anxiety disorders (37.3%), chronic kidney disease (31.2%), diabetes mellitus (28.1%), arthrosis (28.1%), hepatic disorders (25.5%), obesity (24.0%), malignancy (22.5%), left bundle branch (12.2%), Parkinson disease (9.9%), hemorrhagic events (8.7%), stroke (8.4%), peripheral vascular disease (7.2%), anemia (6.8%), and right bundle branch (5.3%). Conclusion - The presence of non valvular AF in HF patients is associated with a high number of risk factors, comorbidities and high in-hospital mortality. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines. The AF-CARE framework is introduced, a structural approach that aims to improve patient care and outcomes, comprising of four pillars: [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, and [E] Evaluation and dynamic reassessment. Additionally, graphical patient pathways are provided to enhance clinical application. A significant shift is the new emphasis on comorbidity and risk factor control to reduce AF recurrence and progression. Individualized assessment of risk is suggested to guide the initiation of oral anticoagulation to prevent thromboembolism. New guidance is provided for anticoagulation in patients with trigger-induced and device-detected sub-clinical AF, ischaemic stroke despite anticoagulation, and the indications for percutaneous/surgical left atrial appendage exclusion. AF ablation is a first-line rhythm control option for suitable patients with paroxysmal AF, and in specific patients, rhythm control can improve prognosis. The AF duration threshold for early cardioversion was reduced from 48 to 24 h, and a wait-and-see approach for spontaneous conversion is advised to promote patient safety. Lastly, strong emphasis is given to optimize the implementation of AF guidelines in daily practice using a patient-centred, multidisciplinary and shared-care approach, with the simultaneous launch of a patient version of the guideline., Competing Interests: Conflict of interest: All authors and collaborators have participated in the 2024 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guideline on Atrial Fibrillation Task force and have submitted declarations of interest which are reported in a supplementary document to the guidelines., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Aims: Sex differences in the epidemiology and clinical management of AF are evident. Of note, females are more symptomatic and if age >65, are at higher risk of thromboembolism if incident AF develops, compared with males., Methods and Results: In an analysis from the dataset of the Euro Observational Research Programme on Atrial Fibrillation (EORP-AF) Pilot survey (n = 3119), we examined sex-related differences in presentation, treatment, and outcome of contemporary patients with AF in Europe.Female subjects were older (P < 0.0001), with a greater proportion aged ≥75 years, with more heart failure and hypertension. Heart failure with preserved ejection fraction was more common in females (P < 0.0001), as was valvular heart disease (P = 0.0003). Females were more symptomatic compared with males with a higher proportion being EHRA Class III and IV (P = 0.0012). The more common symptoms that were more prevalent in females were palpitations (P < 0.0001) and fear/anxiety (P = 0.0007). Other symptoms (e.g. dyspnoea, chest pain, fatigue, etc.) were not different between males and females. Health status scores were significantly lower for females overall, specifically for the psychological and physical domains (both P < 0.0001) but not for the sexual activity domain (P = 0.9023). Females were less likely to have electrical cardioversion (18.9 vs. 25.5%, P < 0.0001), and more likely to receive rate control (P = 0.002). Among patients recruited in hospital and discharged alive (n = 2009), documented contraindications to vitamin K antagonist (VKA) were evident in 23.8% of females. A CHA2DS2-VASc score ≥2 was found in 94.7% of females and 74.6% of males (P < 0.0001), with oral anticoagulants being used in 95.3 and 76.2%, respectively (P < 0.0001). A HAS-BLED score of ≥3 was found in 12.2% of females and 14.5% of males. Independent predictors of VKA use in females on multivariate analysis were CHA2DS2-VASc score (P = 0.0007), lower HAS-BLED score (P = 0.0284), and prosthetic mechanical valves (P = 0.0276)., Conclusion: The EORP-AF Pilot survey provides contemporary data on sex differences in clinical features and management of AF patients participating in the EORP-AF Pilot registry. Female subjects were older and more symptomatic, compared with males, and were more likely to receive rate control. Also, female patients were at higher stroke risk overall, but oral anticoagulation was used in a high proportion of patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)