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Maffei E, Punzo B, Cavaliere C, Bossone E, Saba L, Cademartiri F. Coronary atherosclerosis as the main endpoint of non-invasive imaging in cardiology: a narrative review. Cardiovasc Diagn Ther 2021; 10:1897-1905. [PMID: 33381433 DOI: 10.21037/cdt-20-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The change of paradigm determined by the introduction of cardiac computed tomography (CCT) in the field of cardiovascular medicine has allowed new evidence to emerge. These evidences point towards a major role, probably the most important one in terms of prognostic impact, in the detection, characterization and quantification of atherosclerosis as the main driver and endpoint for the management of coronary artery disease (CAD). Extensive literature has been published in the last decade with large numbers and patients' populations, investigating several aspects and correlations between atherosclerotic plaque features and risk factors; also, the relationship between plaque features, both with qualitative and quantitative approaches, and cardiovascular events has been investigated. More recent studies have also pointed out the relationship between the knowledge and classification of sub-clinical atherosclerosis and the induced modification of medical therapy (both aggressiveness and compliance) that is most likely able to increase the effect of anti-atherosclerotic drugs, hence significantly improving prognosis. Non-invasive assessment of CAD by means of CCT is becoming the primary tool for management and also the most important parameter for the comprehension of natural history of CAD and how the therapies we adopt are affecting plaque burden as a whole. In this review we will address the modern concepts of CAD driven understanding and management of cardiovascular disease.
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Affiliation(s)
- Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy
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Toia P, La Grutta L, Smeraldi T, Agnello F, Grassedonio E, Maffei E, Midiri M, Cademartiri F. Updated diagnostic & prognostic paradigm for CAD: a narrative review. Cardiovasc Diagn Ther 2020; 10:1979-1991. [PMID: 33381438 PMCID: PMC7758757 DOI: 10.21037/cdt-20-526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022]
Abstract
Cardiovascular diseases are the first cause of death globally; early detection of coronary artery disease (CAD) is a challenge for clinicians and radiologists. Over the past 2 decades there have been several improvements in the methods for the assessment of diagnosis and prognosis in patients with suspected CAD; most of these methods are imaging methods and they operate with high-end technologies. Cardiac computed tomography (CCT) as we know it today was introduced in 1998 and has ever progressed with constant pace. The first decade was the technical validation phase of the method while the second decade was the clinical validation phase. CCT has developed an excellent diagnostic and prognostic value; technological development together with radiation dose reduction, contributed to the widening of its clinical indications. The diagnostic value of CCT is particularly important as a first line in symptomatic patients with suspected obstructive CAD and low-to-intermediate cardiovascular risk. It is a test that should come, whenever possible, in front of functional evaluation because of its very high sensitivity and negative predictive value. The prognostic value of CCt is still investigational, even though it is becoming quite evident that the atherosclerotic phenotype plays a major role in the determination of prognosis, and as consequence, in the individualization of optimal pharmacological therapy, especially in the cohort without significant obstructive CAD. Recently, scientific and practical guidelines have been updated taking into account the role of CCT, which is able to provide a reliable and fast diagnosis with an additional resources optimization. Multiple registries and trials have been developed and will be summarized in this review. Recent guidelines highlighted the role of CCT in diagnosing suspected CAD.
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Affiliation(s)
- Patrizia Toia
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Ludovico La Grutta
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities (ProMISE), University of Palermo, Italy
| | - Tommaso Smeraldi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Francesco Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Emanuele Grassedonio
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Massimo Midiri
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
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La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Integrated non-invasive approach to atherosclerosis with cardiac CT and carotid ultrasound in patients with suspected coronary artery disease. LA RADIOLOGIA MEDICA 2016; 122:16-21. [DOI: 10.1007/s11547-016-0692-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
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Di Cesare E, Gennarelli A, Di Sibio A, Felli V, Perri M, Splendiani A, Gravina GL, Barile A, Masciocchi C. 320-row coronary computed tomography angiography (CCTA) with automatic exposure control (AEC): effect of 100 kV versus 120 kV on image quality and dose exposure. Radiol Med 2016; 121:618-25. [PMID: 27169907 DOI: 10.1007/s11547-016-0643-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/18/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare the impact of a 100 kV tube voltage protocol to 120 kV in terms of image quality and radiation dose by a 320 row coronary computed tomography angiography (CCTA) with automatic exposure control (AEC). MATERIALS AND METHODS Using a propensity matched analysis we compared a group of 135 patients scanned using a 100 kV tube voltage protocol with a group of 135 subjects scanned employing a 120 kV tube voltage setting. In all subjects the heart rate (HR) was <65 bpm and all CT scans were acquired using a prospective ECG gating and AEC strategy. Mean effective radiation dose and subjective and objective (Noise or N, signal to noise ratio or SNR, contrast to noise ratio or CNR) image quality, were evaluated. Subjective quality was assessed by two experienced radiologists using a 5-point scale (0: non diagnostic-4: excellent) using the 15-segment American Heart Association (AHA) coronary artery classification. RESULTS Mean effective dose and noise were non significantly different between the two groups: mean effective dose was 2.89 ± 0.7 mSv in the 100 kV group and 2.80 ± 0.57 mSv in the 120 kV group (p = 0.25) while noise was 28.9 ± 3.3 in the 120 kV group and 29.05 ± 3.6 in the 100 kV group (p = 0.72). Both SNR and CNR were significantly higher in the 100 kV group than in the 120 kV group. This data agrees with the evidence that subjective quality was significantly higher in the 100 kV group in the middle and distal segmental classes. CONCLUSION Our study shows that, in using a 320 row CCTA with AEC strategy it is better to employ a 100 kV tube voltage protocol because compared to 120 kV tube voltage setting, it appears to significantly improve both subjective and objective image quality without decreasing the mean effective radiation dose.
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Affiliation(s)
- Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy.
| | - Antonio Gennarelli
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Alessandra Di Sibio
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Valentina Felli
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Marco Perri
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Giovanni Luca Gravina
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
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La Grutta L, Toia P, Farruggia A, Albano D, Grassedonio E, Palmeri A, Maffei E, Galia M, Vitabile S, Cademartiri F, Midiri M. Quantification of epicardial adipose tissue in coronary calcium score and CT coronary angiography image data sets: comparison of attenuation values, thickness and volumes. Br J Radiol 2016; 89:20150773. [PMID: 26987374 DOI: 10.1259/bjr.20150773] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The aim of the study was to compare epicardial adipose tissue (EAT) characteristics assessed with coronary calcium score (CS) and CT coronary angiography (CTCA) image data sets. METHODS In 76 patients (mean age 59 ± 13 years) who underwent CS and CTCA owing to suspected coronary artery disease (CAD), EAT was quantified in terms of density (Hounsfield units), thickness and volume. The EAT volume was extracted with a semi-automatic software. RESULTS A moderate correlation was found between EAT density in CS and CTCA image data sets (-100 ± 19 HU vs -70 ± 24 HU; p < 0.05, r = 0.55). The distribution of EAT was not symmetrical with a maximal thickness at the right atrioventricular groove (14.2 ± 5.3 mm in CS, 15.7 ± 5 mm in CTCA; p > 0.05, r = 0.76). The EAT volume resulted as 122 ± 50 cm(3) in CS and 86 ± 40 cm(3) in CTCA (Δ = 30%, p < 0.05, r = 0.92). After adjustment for post-contrast EAT attenuation difference (Δ = 30 HU), the volume was 101 ± 47 cm(3) (Δ = 17%, p < 0.05, r = 0.92). Based on EAT volume median values, no differences were found between groups with smaller and larger volumes in terms of Agatston score and CAD severity. CONCLUSION CS and CTCA image data sets may be equally employed for EAT assessment; however, an underestimation of volume is found with the latter acquisition even after post-contrast attenuation adjustment. ADVANCES IN KNOWLEDGE EAT may be measured by processing either the CS or CTCA image data sets.
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Affiliation(s)
- Ludovico La Grutta
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Patrizia Toia
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Alfonso Farruggia
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Domenico Albano
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | | | - Antonella Palmeri
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- 2 Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, QC, Canada
| | - Massimo Galia
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Salvatore Vitabile
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Filippo Cademartiri
- 2 Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, QC, Canada.,3 Department of Radiology, Erasmus Medical Center University, Rotterdam, Netherlands
| | - Massimo Midiri
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Cademartiri F, Maffei E. Cardiac CT for the detection of vulnerable plaque. Eur Heart J Cardiovasc Imaging 2015; 17:260-1. [PMID: 26628618 DOI: 10.1093/ehjci/jev307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute, Universitè de Montreal, Montreal, Canada Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands
| | - Erica Maffei
- Centre de Recherche, Montreal Heart Institute, Universitè de Montreal, Montreal, Canada
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Acceptance of noninvasive computed tomography coronary angiography: for a patient-friendly medicine. LA RADIOLOGIA MEDICA 2013; 119:128-34. [DOI: 10.1007/s11547-013-0319-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 07/12/2012] [Indexed: 11/26/2022]
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Mollet N, Maffei E, Martini C, Weustink A, van Mieghem C, Baks T, McFadden E, de Feyter P, Catalano O, Seitun S, Krestin G, Cademartiri F. Coronary plaque burden in patients with stable and unstable coronary artery disease using multislice CT coronary angiography. Radiol Med 2011; 116:1174-87. [PMID: 21892712 DOI: 10.1007/s11547-011-0722-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 07/08/2009] [Indexed: 01/27/2023]
Abstract
PURPOSE We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris. MATERIALS AND METHODS Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner offering a fast rotation time (330 ms) and higher X-ray tube output (900 mAs). To determine the MSCT coronary plaque burden, we assessed the extent (number of diseased segments), size (small or large), type (calcific, noncalcific, mixed) of plaque, its anatomic distribution and angiographic appearance in all available ≥2-mm segments. In a subset of 15 (seven stable, eight unstable) patients, the detection and classification of coronary plaques by MSCT was verified by intracoronary ultrasound (ICUS). RESULTS Sensitivity and specificity of MSCT compared with ICUS to detect significant plaques (defined as ≥1-mm plaque thickness on ICUS) was 83% and 87%. Overall, 473 segments were examined, resulting in 11.6±1.5 segments per patient. Plaques were present in 62% of segments and classified as large in 47% of diseased segments. Thirty-two percent were noncalcific, 25% calcific and 43% mixed. Plaques were most frequently located in the proximal and mid segments. Plaque was found in 33% of segments classified as normal on CCA. Unstable patients had significantly more noncalcific plaques when compared with stable patients (45% vs. 21%, p<0.05). CONCLUSIONS MSCT-CA provides important information regarding the coronary plaque burden in patients with stable and unstable angina.
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Affiliation(s)
- N Mollet
- Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Maffei E, Martini C, Seitun S, Arcadi T, Tedeschi C, Guaricci A, Malagò R, Tarantini G, Aldrovandi A, Cademartiri F. Computed tomography coronary angiography in the selection of outlier patients: a feasibility report. Radiol Med 2011; 117:214-29. [PMID: 21643634 DOI: 10.1007/s11547-011-0695-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/27/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated criteria, presence and distribution of outlier patients by means of computed tomography coronary angiography (CTCA) in a large institutional database. MATERIAL AND METHODS From a population of 2,881 consecutive patients (1,842 men, mean age 62 ± 13 years) in sinus rhythm who underwent CTCA, we extracted data on patients with suspected coronary artery disease (CAD). We selected patient outliers in the fifth and sixth decades of life with the following criteria: ≥ 3 risk factors and absence of CAD, zero to one risk factors and ≥ 5 diseased coronary segments. Diabetes was excluded from risk factors because of the different impact on CAD. RESULTS The patient population consisted of 2,432 individuals with suspected CAD (1,495 men, age 62 ± 13 years). The prevalence of obstructive CAD (≥ 50% lumen reduction at CTCA) was 36% (863/2,432). Patients with normal coronary arteries accounted for 34% of the total (837/2,432; 431 men, age 55 ± 14 years). Of these, 210 were in the fifth and 231 in the 6th decade (men 196, women 245); those with ≥ 3 risk factors accounted for 4.2% of the total (102/2,432; men 42, women 60). Patients with ≥ 5 diseased coronary segments accounted for 28% of the total (686/2,432; 510 men, age 68 ± 10 years). Of these, 115 were in the fifth and 270 in the sixth decade (men 309, women 76); those with zero to one risk factors accounted for 3.0% (73/2,432; men 66, women 7). CONCLUSIONS CTCA is a reliable noninvasive diagnostic modality that can be used to identify outlier patients. This will enable dedicated trials aimed at characterising biomarkers and genomics of protective and nonprotective factors against CAD and its complications.
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Affiliation(s)
- E Maffei
- Dipartimento di Radiologia e del Cuore, c/o Piastra Tecnica - Piano 0, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
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Left ventricular ejection fraction: real-world comparison between cardiac computed tomography and echocardiography in a large population. Radiol Med 2010; 115:1015-27. [PMID: 20221709 DOI: 10.1007/s11547-010-0542-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 08/04/2009] [Indexed: 10/19/2022]
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Stress-ECG vs. CT coronary angiography for the diagnosis of coronary artery disease: a “real-world” experience. Radiol Med 2009; 115:354-67. [PMID: 19902329 DOI: 10.1007/s11547-009-0456-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 04/03/2009] [Indexed: 01/19/2023]
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Abstract
Coronary heart disease remains the leading cause of morbidity and mortality in older adults, despite improved survival and declining mortality. Prevalence in and impact of heart disease on elderly people, increasing risk factors, and the underlying physiologic changes of aging are briefly reviewed. High prevalence of clinical and subclinical heart disease provides a basis for considering opportunities for prevention and follow-up. This article focuses on recently developed noninvasive techniques, such as cardiac multislice CT and cardiac MR imaging.
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Kips JG, Segers P, Van Bortel LM. Identifying the vulnerable plaque: A review of invasive and non-invasive imaging modalities. Artery Res 2008. [DOI: 10.1016/j.artres.2007.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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