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The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC

Optical coherence tomography (OCT) is a novel intravascular imaging modality, based on infrared light emission, that enables a high resolution arterial wall imaging, in the range of 10-20 microns. This feature of OCT allows the visualization of specific components of the atherosclerotic plaques. The aim of the present Expert Review Document is to address the methodology, terminology and clinical applications of OCT for qualitative and quantitative assessment of coronary arteries and atherosclerosis.

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

No abstract

screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidencebased, inexpensive BP-lowering agents.

Objective-To study the time course and underlying mechanisms of right heart filling after cardiac surgery.Design-A prospective observational study of adult patients undergoing cardiac surgery.Setting-Echocardiography laboratory of the Stanford University Medical Center.Patients-Twenty six patients (mean age 54-9) undergoing cardiac surgery were studied before and two days, one week, six weeks, and six months after cardiac surgery.Main outcome measures-Flow in the hepatic veins and superior vena cava, tricuspid and mitral annulus motion, signs of tricuspid regurgitation, and right ventricular size were assessed by echocardiography.Results-Right heart filling, expressed as the ratio of systolic to diastolic forward flow Doppler velocity integrals in the superior vena cava and by tricuspid annulus motion, decreased in parallel from before surgery baseline values of 3*5 (SD 3-1) and 21-9 (3-4) mm, respectively to 02 (01) and 8-1 (2-3) mm two days after operation. A gradual increase towards baseline values was noted after six months, to 1-4 (1-3) and 15.1 (2 3) mm respectively; however, these values were still significantly less than those before operation. Similar changes were seen in the hepatic venous flow pattern. The decrease in total tricuspid annulus motion was most pronounced in its lateral segment and the atrial component of the tricuspid annulus motion showed similar changes.Conclusions-The pronounced decrease in tricuspid annulus motion during the early postoperative period suggests right atrial and right ventricular dysfunction as mechanisms responsible for the early changes-seen. The progressive return to a normal venous filling pattern and the partial recovery of annular motion six months after operation further support the influence ofthe above mechanisms, as well as their resolution with time. The persistent flow abnormalities and compromised motion of the free aspects of the tricuspid annulus, however, suggest long-term tethering of the right heart walL Right heart filling, reflected in the pattern of systemic venous return, becomes abnormal in patients who undergo cardiac surgery supported by cardiopulmonary bypass.'-' These changes were first described as an alteration in jugular venous pulse contours and flow velocities from the normal dominant systolic flow to an equal or dominant diastolic flow.45 Recently we have shown, using intraoperative transoesophageal echocardiography, that the venous flow pattern is normal before cardiopulmonary bypass even with the pericardium fully opened, but becomes abnormal immediately after termination of cardiopulmonary bypass.6 A mechanical impediment to cardiac motion and a combination of abnormalities in right heart function were suggested as possible mechanisms for these changes immediately after cardiopulmonary bypass. The present study was undertaken to further elucidate the time course and underlying mechanisms of these changes through repeated observations before and during a six month period after operation. Patients and methods PATIENT POPULATION...

The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life and >2.8 million deaths each year. Obesity is relapsing, progressive and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognising resource and support variances between countries).