Background: Catheter ablation combined with left atrial appendage closure is effective in treating atrial fibrillation. However, the effectiveness of this combined treatment compared with catheter ablation alone is still controversial.
Methods: We searched studies in databases, including The Cochrane Library, PubMed, EMBASE, and Web of Science, that compared catheter ablation combined with left atrial appendage closure and catheter ablation alone in the treatment of atrial fibrillation. These studies reported at least one of the following outcomes: the freedom from atrial arrhythmia rate, the procedure time, the fluoroscopy time, perioperative complications, thromboembolic events, and bleeding events during follow-up. The risk ratio and standard mean difference with 95% CI were analyzed by the random-effects model.
Results: Five studies involving 699 people were included in our meta-analysis. We found no significant difference in the freedom from atrial arrhythmia rate (risk ratio=0.93, 95% CI=0.83-1.04, I 2=0%, P=.21) between the 2 groups. Catheter ablation combined with left atrial appendage closure showed significantly longer procedure and fluoroscopy
times than catheter ablation alone (standard mean difference=1.26, 95% CI=0.85-1.67, P <.00001 and standard mean difference=1.19, 95% CI=0.53-1.85, P=.0004, respectively). With regard to safety outcomes, no significant differences were observed in perioperative complications (RR=1.62, 95% CI=0.99-2.63, I 2=0%, P=.05), thromboembolic events (RR=0.67, 95% CI=0.15-3.11, I 2=0%, P=.61), or bleeding events (RR=0.67, 95% CI=0.11-3.88, P=.65) between the 2 groups during follow-up.
Conclusion: The freedom from atrial arrhythmia rate and safety outcomes of catheter ablation combined with left atrial appendage closure are similar to those of catheter ablation alone. Catheter ablation combined with left atrial appendage closure appears to have longer procedure and fluoroscopy times than catheter ablation alone.

As the incidence of coronary heart disease increases annually, coronary angiography and percutaneous coronary intervention procedures are also increasing. The femoral artery and radial artery paths are commonly used for percutaneous coronary intervention, but their clinical application is limited to a certain extent due to many postoperative complications. The distal transradial access path is a new surgical path for coronary angiography and percutaneous coronary intervention. In this study, we reviewed the most relevant and recent articles related to distal transradial access and found that coronary angiography or interventional therapy using the distal transradial access path is safe and effective in patients with acute coronary syndrome and complex coronary artery disease. The distal transradial access path is expected to be the first choice for coronary angiography or percutaneous coronary intervention in patients with acute coronary syndrome and complex coronary artery disease.

Background: Data concerning the comparison between transcatheter aortic valve implantation and surgical aortic valve replacement in a real-world setting are scarce and in Central and Eastern Europe no such data exist. In this study, we aimed at analyzing retrospectively the characteristics and outcome of patients with aortic stenosis treated either with surgical aortic valve replacement or transcatheter aortic valve implantation between 2006 and 2016 in the Silesian Province, Poland in a representative real-world cohort.
Methods: In the Silesian Cardiovascular Database we retrospectively identified 5186 patients who received either transcatheter aortic valve implantation or surgical aortic valve replacement in 1 of 3 tertiary cardiovascular centers. Baseline characteristics, including relevant clinical history, and outcomes were compared before and after propensity-score matching of both groups, with 348 pairs of patients constituting the
propensity-matched study cohort. The primary end-point was 24-month all-cause mortality.
Results: Preoperative characteristics of propensity-matched groups were similar. There was no difference between transcatheter aortic valve implantation and surgical aortic valve replacement groups with respect to the death rate at 2 years (19.9% vs. 15.6%; P =
.479). In the transcatheter aortic valve implantation group, cardiac resynchronization therapy devices were more frequently implanted after the procedure (3.7% vs. 0.0, P <.001). The groups had similar rates of myocardial infarction, stroke, and re-hospitalization. Hospital stay in the matched groups was shorter after transcatheter aortic valve implantation: 14.1 versus 15.7 days (P <.001).
Conclusions: At 24 months, transcatheter aortic valve implantation patients had similar outcomes as surgical aortic valve replacement except for a higher rate of cardiac resynchronization therapy device implantation and shorter hospital stay.

Background: Lower extremity arterial disease is usually a widespread vessel disease of atherosclerotic origin with a predisposition for certain anatomical sites. This study aimed to evaluate the relationship between lower extremity arterial disease anatomic and clinical features and various sitting patterns.
Methods: Patients who underwent invasive peripheral angiography and who were diagnosed with lower extremity arterial disease in a single tertiary center were included in the study. Six sitting positions were defined. Sitting patterns and other clinical data were collected using a standardized questionnaire.
Results: In this study, 150 patients diagnosed with lower extremity arterial disease who underwent invasive peripheral angiography were enrolled. The mean age of the study population was 66.2 ± 9.5 years, and an overwhelming majority of the participants were men (91.3% vs. 8.7%). A significant relationship was found between sitting positions #1-5 and right-sided lesions, as well as sitting positions #1-4 and left-sided lesions (sitting position #5 and right-sided lesions P=.039, all others P <.001). Longer and more frequent sitting conditions were found to be associated with lesions in the proximal arteries (common iliac artery and external iliac artery) but not in the more distal artery (superficial femoral artery, popliteal artery, anterior tibial artery, and posterior tibial artery) lesions.
Conclusions: A clear relationship between sitting positions and lower extremity arterial disease sites was demonstrated. This data indicate that sitting patterns should be evaluated in every lower extremity arterial disease patient.

Background: Myocardial infarction has been recognized globally as a serious problem featured with high mortality and morbidity. In addition, hypoxia represents the central feature of myocardial infarction. Recently, it has been reported that circular RNAs can exert critical functions in the biological processes of diseases. However, the functions of most circular RNAs remain unclear in cells cultured under hypoxic conditions. In this study, we focused on exploring the role of circ_SMAD7 (namely hsa_circ_0000848 in this study) in cardiomyocyte cells cultured under hypoxic conditions to provide a novel insight for future myocardial infarction studies.
Methods: Firstly, a real-time quantitative polymerase chain reaction assay was adopted to analyze hsa_circ_0000848 expression. Functional assays were performed to detect the functions of hsa_circ_0000848 in cardiomyocyte cells cultured under hypoxic conditions. Furthermore, mechanism assays were implemented to explore the regulatory mechanism of hsa_circ_0000848.
Results: Hsa_circ_0000848 was notably downregulated in hypoxia-induced cardiomyocytes. The silencing of hsa_circ_0000848 hindered the proliferation while accelerating the apoptosis of hypoxia-induced cardiomyocytes cells. Moreover, hsa_circ_0000848 interacted with ELAV-like RNA-binding protein 1 protein to stabilize SMAD family member 7 mRNA. Moreover, SMAD family member 7 overexpression could reverse the suppressive effect of hsa_circ_0000848 knockdown on myocardial infarction progression.
Conclusions: Our research was the first in the field to confirm that the hsa_circ_0000848/ ELAV-like RNA-binding protein 1/SMAD family member 7 axis could affect the development of cardiomyocyte cells cultured under hypoxia, indicating that hsa_circ_0000848 might function as a novel biomarker in cells under hypoxia thus laying the groundwork for future study on myocardial infarction.

Background: Tricuspid regurgitation is a condition that affects 1.6 million patients in the United States and is independently associated with morbidity and mortality. The TriClip™ procedure repairs the tricuspid valve without the need for open-heart surgery. The aim of this study is to evaluate the cost-effectiveness of TriClip™ treatment in patients with advanced tricuspid regurgitation from the Turkish reimbursement agency perspective.
Methods: Within the scope of this study, the general literature was searched in order to reach data on tricuspid regurgitation. The utilization of health care services used in the expert panel was re-calculated with the current reimbursement costs to determine the cost of heart failure in Turkey. In this study, Markov analysis, Tornado analysis, cost-effectiveness analysis, and partitioned survival analysis have been performed to determine whether TriClip™ is an effective treatment method compared to medication treatment.
Results: In according to calculations, 5-year survival rate was found as 49.91% for medication treatment and 57.64% for TriClip™ treatment. According to the analysis performed, the cost of medication treatment was calculated as €3879.72 and TriClip™ Transcatheter Tricuspid Valve Repair System treatment as €25 661.15 for a 60-month period in patients with tricuspid regurgitation and New York Heart Association III-IV. In the calculation, it was found that TriClip™ treatment gave patients an average of 1.64 life years and it was found to be cost-effective compared to medication treatment.
Conclusions: Considering the positive effect of TriClip™ treatment on patients with tricuspid regurgitation in terms of mortality and regression of the heart failure stage, as recommended in the guidelines, widespread of its use has great importance.

Background: Introduction of simple bedside tools for assessing patients’ condition in different settings improves triaging. However, these indices are less frequently used in heart failure. This study aims to evaluate the utility of shock index, age shock index, modified shock index, and age-modified shock index in the prediction of in-hospital mortality in acute decompensated heart failure individuals.
Methods: We conducted this retrospective study on 3652 acute decompensated heart failure individuals in the context of Persian Registry of Cardiovascular Disease/heart failure. Shock index, age shock index, modified shock index, and age-modified shock index were assessed during admission. Receiver operating characteristic curve was used to define the optimum cut-off point. Odds ratio models were used for investigating the association of in-hospital mortality according to each specified cut-off value.
Results: Mean age was 70.12 ± 12.56 years (males: 62.6%). Optimum cut-off point for shock index, age shock index, modified shock index, and age-modified shock index were set to be 0.71 (sensitivity: 63%, specificity: 60%), 50.5 (sensitivity: 65%, specificity: 60%), 0.94 (sensitivity: 60%, specificity: 60%), and 66.7 (sensitivity: 62%, specificity: 60%), respectively. Participants with higher shock index derivatives in all domains had significantly higher likelihood of death. Compared to those with shock index, age shock index, modified shock index, and age-modified shock index values of less than cut-off points, adjusted model revealed patients with higher values had 2.59 (95% CI: 1.94-3.46, P<.001), 2.61 (95% CI: 1.95-3.48, P <.001), 2.14 (95% CI: 1.61-2.84, P <.001), and 2.28 (95% CI: 1.72- 3.03, P <.001) times increase in-hospital death risk, respectively.
Conclusions: Shock index, age shock index, modified shock index, and age-modified shock index are simple bedside tools to reliably predict in-hospital mortality in acute decompensated heart failure patients to better prioritize high-risk subjects.

Objective: To investigate the safety and efficacy of a percutaneous revascularization strategy that is based on the use of drug-coated balloon for the treatment of patients with acute coronary syndrome and de novo Medina type 0,1,0 or 0,0,1 left main stem bifurcation lesions.
Methods: In this multicenter, prospective, proof-of-concept study, patients fulfilling the
above criteria were enrolled and received treatment with drug-coated balloon combined with provisional drug-eluting stent implantation in the proximal major branches of the left main stem. Patients who declined this revascularization approach were treated with drug-eluting stent implantation 1-2 mm distally to the left anterior descending or left circumflex artery ostium followed by drug-coated balloon therapy for the ostial disease. The primary endpoint of the study was the calculation of percent diameter stenosis on quantitative coronary angiography post-procedure as well as event rate at 8 months follow-up.
Results: A total of 30 patients were enrolled in the study; their mean age was 60.3 ± 7.8 years, while 22 (73.3%) were male. Twenty-two patients were treated only with drugcoated balloon and provisional drug-eluting stent implantation and 8 had drug-eluting stent implantation followed by drug-coated balloon therapy of the ostium of the left main stem major branch. All the procedures were successful with no immediate complications. The percent diameter stenosis of lesion decreased significantly post-procedure from 87.5% (80.0-90.0) to 20% (17.5-30.0), P <.001. During the follow-up period, no major adverse cardiac events were reported.
Conclusions: This proof-of-concept study indicates that ostial drug-coated balloon therapy of the left main stem major branches is safe and effective. Larger clinical data and longer follow-up are needed before advocating its regular use in clinical practice.