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Schwartz B, Schou M, Ruberg FL, Rucker D, Choi J, Siddiqi O, Monahan K, Køber L, Gislason G, Torp-Pedersen C, Andersson C. Cardiovascular Morbidity in Monoclonal Gammopathy of Undetermined Significance: A Danish Nationwide Study. JACC CardioOncol 2022; 4:313-322. [PMID: 36213365 PMCID: PMC9537076 DOI: 10.1016/j.jaccao.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Monoclonal gammopathy of undetermined significance (MGUS) is associated with renal dysfunction, inflammation, and increased cardiovascular mortality, but the cardiovascular risks are not fully understood. Objectives The authors explored the association of MGUS with a spectrum of cardiovascular diseases using the Danish nationwide databases. Methods Between 1995 and 2018, patients 18 years and older with MGUS were age- and sex-matched (1:10) with control patients and followed prospectively until December 31, 2018, for the occurrence of cardiovascular diseases. Patients diagnosed with multiple myeloma, lymphoma, or amyloidosis were excluded. Multivariable adjusted hazard ratios (HRs) for cardiovascular outcomes were estimated using Cox proportional hazard regression. Results Patients with MGUS (n = 8,189; mean age 69.8 ± 11.7 years; 51.2% male) had higher prevalence of cardiovascular risk factors at baseline, including hypertension (48.0% vs 38.5%) and type 2 diabetes (13.0% vs 9.3%), compared with control patients. Outcomes included an increased risk of heart failure (HR: 1.55; 95% CI: 1.41-1.69), acute myocardial infarction (HR: 1.22; 95% CI: 1.06-1.40), ischemic stroke (HR: 1.16; 95% CI: 1.03-1.30), atrial fibrillation (HR: 1.32; 95% CI: 1.23-1.42), aortic aneurysm (HR: 1.55; 95% CI: 1.28-1.89), aortic stenosis (HR: 1.60; 95% CI: 1.41-1.82), aortic regurgitation (HR: 1.67; 95% CI: 1.34-2.07), heart block (HR: 1.32; 95% CI: 1.08-1.61), peripheral artery disease (HR: 1.69; 95% CI: 1.47-1.95), cor pulmonale (HR: 2.06; 95% CI: 1.55-2.73), and venous thromboembolism (HR: 1.43; 95% CI: 1.24-1.65). A sensitivity analysis including only patients without certain comorbidities (type 2 diabetes, hypertension, acute myocardial infarction, and chronic kidney disease) yielded similar results. Conclusions MGUS is associated with a broad spectrum of cardiovascular diseases, with greater relative risks observed for diseases previously associated with infiltrative and inflammatory disorders. Further studies are warranted to explore the underlying mechanisms.
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Affiliation(s)
- Brian Schwartz
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA,Address for correspondence: Dr Brian Schwartz, Department of Medicine, Section of Internal Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA. @BSchwarMD@ca_heart_dk
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark
| | - Frederick L. Ruberg
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dane Rucker
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jihoon Choi
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Omar Siddiqi
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Monahan
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lars Køber
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark,The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Hillerød Hospital, Hillerød, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark,Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Hudak M, Sardana R, Parwani AV, Mathewson RC, Gibson CG, Cohen PA, Lazarus JJ, Bruce JT, Son JH, Tynski Z. Light chain deposition disease presenting as an atrial mass: a case report and review of literature. Cardiovasc Pathol 2021; 55:107368. [PMID: 34324992 DOI: 10.1016/j.carpath.2021.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
Light chain deposition disease (LCDD) also known as nonamyloidotic immunoglobulin deposition disease is a rare systemic disorder due to the abnormal deposition of immunoglobulin in multiple organs caused by the clonal proliferation of B lymphocytes and plasma cells. Renal involvement is the most common with cardiac manifestations being the most common extra renal presentation of the disease. Renal involvement is not always associated with LCDD. Isolated cardiac involvement can manifest in a wide variety of ways: heart failure, cardiomyopathy, arrhythmias, angina, myocardial infarction, etc. We hereby present an unusual case of 59-year-old female who presented to clinic for routine follow up. A murmur on physical exam was evaluated with echocardiogram which led to the discovery of an incidental right atrial mass. Cardiac magnetic resonance imaging was completed 6 months later for follow up which showed increasing size of the mass. The mass was excised and found to be consistent with LCDD. To the best of our knowledge, this is the first reported case of LCDD manifesting as an atrial mass. Through this case report and review of literature we would like to generate awareness among our fellow pathologists and clinicians to maintain a high level of suspicion for LCDD as it can manifest in many unusual ways, with or without kidney involvement.
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Affiliation(s)
- Madeline Hudak
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Ruhani Sardana
- Department of Pathology, The Ohio State University Medical Center and Comprehensive Cancer Center, Columbus, Ohio
| | - Anil V Parwani
- Department of Pathology, The Ohio State University Medical Center and Comprehensive Cancer Center, Columbus, Ohio
| | | | | | - P Aryeh Cohen
- Department of Cardiothoracic Surgery, Fairfield Medical Center, Lancaster, Ohio
| | - John J Lazarus
- Department of Cardiology, Fairfield Medical Center, Lancaster, Ohio
| | - Jarrod T Bruce
- Department of Pulmonary Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Jae H Son
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Zofia Tynski
- Department of Pathology, Fairfield Medical Center, Lancaster, Ohio.
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Sobue Y, Takemura G, Kawamura S, Yano T, Kanamori H, Morimoto SI, Matsuo H. Coexistence of amyloidosis and light chain deposition disease in the heart. Cardiovasc Pathol 2020; 51:107315. [PMID: 33264681 DOI: 10.1016/j.carpath.2020.107315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022] Open
Abstract
There are few reports on the coexistence of cardiac amyloid light-chain (AL) amyloidosis and light chain deposition disease (LCDD), despite their similar pathophysiologies caused by plasma-cell dyscrasia. Herein, we report the coexistence of these diseases. A 59-year-old man was referred to our hospital because of exertional dyspnea and hypotension. Renal dysfunction of unknown etiology had been present for 4 years and hemodialysis had been introduced. Severe systolic and diastolic cardiac dysfunction was apparent, accompanied with dilatation and granular sparkling, but not with left ventricular hypertrophy. The plasma-free light chain κ was found to be extremely high, with a κ/λ ratio of 1,919. Light microscopic examination of the endomyocardial biopsy revealed spotty and homogenous deposits, which positively stained with Congo red, and exhibited a blazing apple-green color under polarized light. Based on these results, cardiac amyloidosis was diagnosed. In specimens prepared for electron microscopy, no amyloid fibrils could be found. Instead, we observed amorphous nonfibrillar deposits around several small vessels including capillaries and small arteries, which were consistent with light-chain deposits. LCDD was diagnosed based on the systemic increase in κ light chain and the ultrastructural findings of the endomyocardial biopsy specimens. Coexistence of cardiac amyloidosis and LCDD was thus confirmed in our patient. An electron microscopic assessment in addition to Congo red staining may be useful to diagnose latent LCDD in patients with suspected cardiac light-chain amyloidosis.
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Affiliation(s)
- Yoshihiro Sobue
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
| | - Genzou Takemura
- Department of Internal Medicine, Asahi University School of Dentistry, Mizuho, Japan
| | - Shunji Kawamura
- Department of Pathology, Itabashi Medical Laboratory, EIL Inc., Tokyo, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromitsu Kanamori
- Department of Cardiology, Gifu University School of Medicine, Gifu, Japan
| | - Shin-Ichiro Morimoto
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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Abdallah AOA, Alapat D, Kaur V, Atrash S. Outcomes of autologous stem cell transplant for cardiac AL-amyloidosis and cardiac light chain deposition disease. J Oncol Pharm Pract 2019; 26:1128-1133. [PMID: 31795821 DOI: 10.1177/1078155219888564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cardiac amyloidosis and light chain deposition disease (LCDD) are the most common cause of death in AL amyloidosis or LCDD. METHODS Our multiple myeloma database identified 50 patients with cardiac amyloidosis or LCDD between January 2004 and January 2013. Descriptive analyses were performed on available data for patient characteristics, disease course, and outcomes. RESULTS The median age at diagnosis was 61 years for those who received autologous hematopoietic stem cell transplant (ASCT) and 71 years for those who received only bortezomib-based chemotherapy; 62.5% (n = 30) of patients had elevated levels of NT-proBNP ≥323 ng/L, and 29.2% (n = 14) of patients had an elevated cTnT ≥0.1 µg/L. Echocardiogram findings showed a speckled appearance in 18% (n = 9) of patients, and 60% (n = 30) of patients had an increased diastolic intra-ventricular septum (IVSD) thickness measuring ≥1.3 cm; 64.3% (n = 18) of patients who underwent cardiac MRI showed subendocardial enhancement. Out of 48 patients who received treatment, 37 patients were diagnosed with cardiac amyloidosis and 11 patients were diagnosed with cardiac LCDD. Twenty-eight patients (75.7%) with cardiac amyloidosis received ASCT, compared to 34.3% (n = 9) patients who were ineligible for ASCT and received chemotherapy only. Patients who underwent ASCT had a median OS of 4.48 years compared to 1.82 years (p = 0.69) for those receiving chemotherapy alone. CONCLUSION Our single institution experience shows that ASCT is feasible for cardiac amyloidosis and/or cardiac LCDD. However, careful selection of proper patients and diligent supportive care are vital to decreasing transplant-related mortality.
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Affiliation(s)
- Al-Ola A Abdallah
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, School of Medicine, Kansas University Medical Center, Kansas City, KS, USA
| | - Daisy Alapat
- Department of Pathology, College of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, AR, USA
| | - Varinder Kaur
- Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, Virginia, VA, USA
| | - Shebli Atrash
- Department of Hematology Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, NC, USA
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Sanchis K, Cariou E, Colombat M, Ribes D, Huart A, Cintas P, Fournier P, Rollin A, Carrié D, Galinier M, Maury P, Duparc A, Lairez O. Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis: clinical and echocardiographic features, impact on mortality. Amyloid 2019; 26:128-138. [PMID: 31172799 DOI: 10.1080/13506129.2019.1620724] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Atrial fibrillation (AF) commonly affects patients with cardiac amyloidosis (CA). Amyloid deposition within the left atrium may be responsible for the subtype of AF in either permanent or non-permanent form. The prognostic implications of AF and its clinical subtype according to the type of CA are still controversial in this population. This study sought to investigate the prevalence, incidence and prognostic implications of AF and the clinical subtype of AF (permanent or non-permanent) in patients with CA. Methods: Two hundred and thirty-eight patients with CA and full medical records were retrospectively enrolled in the study: About 115 (48%) with light chain (AL) amyloidosis and 123 (52%) with transthyretin amyloidosis (ATTR). Patient's medical records were reviewed to establish baseline prevalence, incidence and impact on all-cause and cardiovascular mortality during follow-up of AF. Results: One hundred and four (44%) patients had history of AF at the time of diagnosis: 62 (60%) permanent and 42 (40%) non-permanent. There were 30 (26%) and 74 (60%) patients with history of AF among patients with AL and ATTR (including 5 hereditary and 69 wild-type), respectively (p<.0001). During the follow-up, 48 new patients developed AF (29, 12 and 7 among patients with AL, wild-type ATTR and hereditary ATTR). After adjustment for age, survival was similar in patients with or without history of AF (HR 0.87 (95% CI, 0.60 to 1.27; p = .467). AF had no impact on cardiovascular mortality. Among the 152 patients with history of AF included in the whole study, there were 75 (49%) patients with permanent AF. After adjustment for age, survival was similar in patients with permanent and non-permanent AF: HR 1.29 (95% CI, 0.84 to 1.99; p = .251). The results were the same among patients with AL or wild-type amyloidosis. Subtype of AF had no impact on cardiovascular mortality. Conclusions: AF is common in patients with CA. However, AF and clinical subtype of AF have no impact on all-cause mortality, whatever the type of amyloidosis.
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Affiliation(s)
- Kevin Sanchis
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France.,b Cardiac Imaging Center, Toulouse University Hospital , Toulouse , France
| | - Eve Cariou
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France.,b Cardiac Imaging Center, Toulouse University Hospital , Toulouse , France.,c Medical School of Rangueil, University Paul Sabatier , Toulouse , France
| | - Magali Colombat
- d Department of Pathology, Toulouse University Hospital , Toulouse , France
| | - David Ribes
- e Department of Nephrology and Organ Transplantation, University Hospital of Rangueil , Toulouse , France.,f Referral Inter for Rare Renal Diseases, Toulouse University Hospital , Toulouse , France
| | - Antoine Huart
- e Department of Nephrology and Organ Transplantation, University Hospital of Rangueil , Toulouse , France.,f Referral Inter for Rare Renal Diseases, Toulouse University Hospital , Toulouse , France
| | - Pascal Cintas
- g Department of Neurology, Purpan University Hospital , Toulouse , France
| | - Pauline Fournier
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France.,b Cardiac Imaging Center, Toulouse University Hospital , Toulouse , France
| | - Anne Rollin
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France
| | - Didier Carrié
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France.,b Cardiac Imaging Center, Toulouse University Hospital , Toulouse , France.,h Medical School of Purpan, University Paul Sabatier , Toulouse , France
| | - Michel Galinier
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France.,b Cardiac Imaging Center, Toulouse University Hospital , Toulouse , France.,c Medical School of Rangueil, University Paul Sabatier , Toulouse , France
| | - Philippe Maury
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France.,h Medical School of Purpan, University Paul Sabatier , Toulouse , France.,i Unite Inserm U 1048 , Toulouse , France
| | - Alexandre Duparc
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France
| | - Olivier Lairez
- a Department of Cardiology, Rangueil University Hospital , Toulouse , France.,b Cardiac Imaging Center, Toulouse University Hospital , Toulouse , France.,h Medical School of Purpan, University Paul Sabatier , Toulouse , France.,j Department of Nuclear Medicine, Toulouse University Hospital , Toulouse , France
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An unusual cause of pulmonary outflow obstruction: IgG4 deposition disease-MRI observations. Int J Cardiovasc Imaging 2018; 35:505-506. [PMID: 30341671 DOI: 10.1007/s10554-018-1454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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7
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Rekhtina IG, Mendeleeva LP, Biryukova LS. [Light-chain deposition disease is a hematologic problem]. TERAPEVT ARKH 2017; 89:38-42. [PMID: 28252625 DOI: 10.17116/terarkh201789138-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To analyze clinical and laboratory data and treatment results in patients with light-chain deposition disease (LCDD). SUBJECTS AND METHODS Nine patients with LCDD and kidney injury were examined. The diagnosis was based on the results of light and immunofluorescence microscopy of renal biopsy specimens. All the patients received bortezomib, cyclophosphamide, and dexamethasone (VCD) induction therapy. RESULTS Six patients were diagnosed with multiple myeloma; in 3 patients LCDD was considered within monoclonal gammopathy manly involving the kidney. By the initiation of therapy, all the patients were diagnosed as having chronic kidney disease (Stage III (n=2), Stage IV (n=2), and dialysis-related renal failure (n=5)). After the VCD treatment, 7 of 9 patients achieved a hematologic response. Second-line therapy with lenalidomide proved to be effective in the other 2 cases. Five patients achieved complete remission; 3 had a very good partial remission. Thereafter, 2 patients received high-dose melphalan chemotherapy and autologous hematopoietic stem cell transplantation. Better renal function was noted in only 2 cases. CONCLUSION Despite the high efficiency of therapy aimed to reduce monoclonal light chains; improved renal function was observed in only 2 (22%) patients. Such low rates of a renal response were due to the late initiation of therapy.
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Affiliation(s)
- I G Rekhtina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - L P Mendeleeva
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - L S Biryukova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
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Bonderman D, Agis H, Kain R, Mascherbauer J. Amyloid in the heart: an under-recognized threat at the interface of cardiology, haematology, and pathology. Eur Heart J Cardiovasc Imaging 2016; 17:978-80. [DOI: 10.1093/ehjci/jew130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Pilot study for left ventricular imaging phenotype of patients over 65 years old with heart failure and preserved ejection fraction: the high prevalence of amyloid cardiomyopathy. Int J Cardiovasc Imaging 2016; 32:1403-1413. [PMID: 27240600 DOI: 10.1007/s10554-016-0915-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/20/2016] [Indexed: 12/11/2022]
Abstract
Tc-DPD are helpful imaging tools for accurate phenotyping of patients amenable to histopathological diagnosis or genetic testing, and should be considered for proper management of this population. Further longitudinal investigations are needed to better clarify these preliminary results.
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De Lazzari M, Fedrigo M, Migliore F, Cianci A, Cacciavillani L, Tarantini G, Giorgi B, Iliceto S, Thiene G, Valente M, Angelini A, Adami F, Perazzolo Marra M. Nonamyloidotic Light Chain Cardiomyopathy. Circulation 2016; 133:1421-3. [DOI: 10.1161/circulationaha.115.019895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Manuel De Lazzari
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Marny Fedrigo
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Federico Migliore
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Andrea Cianci
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Luisa Cacciavillani
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Benedetta Giorgi
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Sabino Iliceto
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Gaetano Thiene
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Marialuisa Valente
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Annalisa Angelini
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Fausto Adami
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- From Department of Cardiac, Thoracic and Vascular Sciences (M.D.L., M.F., F.M., A.C., L.C., G. Tarantini, S.I., G. Thiene, M.V., A.A., M.P.M.), Radiology (B.G.), and Hematology and Clinical Immunology Unit (F.A.), University of Padua, Padua, Italy
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Mohan M, Gokden M, Gokden N, Schinke C. A Case of Cardiac Light Chain Deposition Disease in a Patient with Solitary Plasmacytoma. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:173-6. [PMID: 26988342 PMCID: PMC4801155 DOI: 10.12659/ajcr.895762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 31 Final Diagnosis: Light chain depsotion disease Symptoms: — Medication: — Clinical Procedure: None Specialty: Hematology
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Affiliation(s)
- Meera Mohan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Murat Gokden
- Department of Pathology , University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neriman Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Carolina Schinke
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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12
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Talukdar A, Mukherjee K, Khanra D, Saha M. Portal hypertension related to light chain deposition disease of liver: an enlightening experience. BMJ Case Rep 2013; 2013:bcr2013009553. [PMID: 23723105 PMCID: PMC3669975 DOI: 10.1136/bcr-2013-009553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old alcoholic man presented with firm hepatomegaly, ascites and markedly elevated alkaline phosphatase. He had a history of pulmonary tuberculosis. Work-up for malignancy was negative. Histological examination of liver showed extracellular deposition of pink amorphous material which is Congo red stain negative. Deteriorating renal function and nephrotic-range proteinuria were noted. Renal histology showed thickening of the glomerular and tubular basement membranes by non-congophilic deposits along with mesangial expansion. Bone marrow examination revealed patchy areas of pink amorphous deposits which are Congo red stain negative. Immunohistochemical staining of amorphous depositions in liver, kidney and bone marrow were positive for κ light chains. Serum-free light chain assay confirmed markedly elevated free κ-light chain. κ-light chain deposition disease is a systemic disease with universal renal involvement but rarely it presents as chronic cholestatic liver disease with portal hypertension and frequently associated with fatal outcome due to diagnostic delay.
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Affiliation(s)
- Arunansu Talukdar
- Department of General Medicine, Medical College, Kolkata, West Bengal, India.
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Sasaki K, Chang A, Najafian B. Indolent systemic mastocytosis associated with light chain deposition disease. Clin Kidney J 2012; 5:424-7. [PMID: 26019820 PMCID: PMC4432416 DOI: 10.1093/ckj/sfs104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 07/17/2012] [Indexed: 11/18/2022] Open
Abstract
Systemic mastocytosis (SM) is characterized by infiltration of neoplastic mast cells in one or more organ systems. SM in association with plasma cell dyscrasia is very rare. We report a first case of indolent SM (ISM) associated with light chain deposition disease (LCDD) in a kidney biopsy from a 59-year-old female presenting with skin rash, elevated serum creatinine, hematuria and mild proteinuria. Subsequent workup demonstrated IgG kappa monoclonal protein in serum and urine. A bone marrow biopsy revealed neoplastic mast cells involving bone marrow without evidence of clonal myeloid or lymphoid proliferation. Kidney biopsy demonstrated modest mesangial expansion detected by light microscopy and unequivocal evidence of monoclonal kappa light chain deposition within glomerular capillaries, tubular basement membranes and vascular walls detected by immunofluorescence and/or electron microscopy, along with equivocal evidence of light chain cast nephropathy. Despite treatment with bortezomib and dexamethasone, her renal function was progressively declined over the next 6 months. This case is a reminder that SM can coincide with LCDD, which requires clinical suspicion and multimodality workup on a kidney biopsy including immunofluorescence and electron microscopy to reach the correct diagnosis.
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Affiliation(s)
- Kotaro Sasaki
- Department of Pathology , University of Washington Medical Center , Seattle, WA 98195 , USA
| | - Alice Chang
- Nephrology , Group Health Cooperative , Seattle, WA 98112 , USA
| | - Behzad Najafian
- Department of Pathology , University of Washington Medical Center , Seattle, WA 98195 , USA
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Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovasc Pathol 2012; 21:2-16. [DOI: 10.1016/j.carpath.2011.01.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 01/07/2011] [Indexed: 01/12/2023] Open
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Intimal IgM lambda paraprotein deposition in myocardial arteries resulting in acute myocardial infarction and sudden death. Pathology 2011; 43:732-4. [DOI: 10.1097/pat.0b013e32834c7ed1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Endomyocardial biopsy (EMB) is widely used for surveillance of cardiac allograft rejection and for the diagnosis of unexplained ventricular dysfunction. Typically, EMB is performed through the jugular or femoral veins and is associated with a serious acute complication rate of less than 1% using current flexible bioptomes. Although it is accepted that EMB should be used to monitor for rejection after transplant, use of EMB for the diagnosis of various myocardial diseases is controversial. Diagnosis of myocardial disease in the nontransplant recipient is often successful via noninvasive investigations including laboratory evaluation; echocardiography, nuclear studies, and magnetic resonance imaging can yield specific diagnoses in the absence of invasive EMB. Therefore, use of the technique is patient specific and depends on the potential prognostic and treatment information gained by establishing a pathologic diagnosis beyond noninvasive testing.
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Affiliation(s)
- Aaron M From
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Basnayake K, Stringer SJ, Hutchison CA, Cockwell P. The biology of immunoglobulin free light chains and kidney injury. Kidney Int 2011; 79:1289-301. [DOI: 10.1038/ki.2011.94] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kwon JH, Jeong SH, Kim JW, Bang SM, Kim H, Kim YH, Song SH. Case report: A case of light chain deposition disease involving liver and stomach with chronic hepatitis C virus infection and hepatocellular carcinoma. J Med Virol 2011; 83:810-4. [DOI: 10.1002/jmv.22050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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George JC, Katrapati P, Fang J. An unusual case of biopsy-negative amyloid cardiomyopathy. ACTA ACUST UNITED AC 2010; 16:39-41. [PMID: 20078626 DOI: 10.1111/j.1751-7133.2009.00115.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jon C George
- University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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Zidar N, Zver S, Jurcić V. Extraosseus plasmacytoma of the pharynx with localized light chain deposition. Case report. Pathol Oncol Res 2009; 16:249-52. [PMID: 19967475 DOI: 10.1007/s12253-009-9218-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 10/20/2009] [Indexed: 01/10/2023]
Abstract
Light chain deposition disease (LCDD) is a rare disorder associated with a clonal proliferation of plasma cells, which synthesize abnormal monoclonal immunoglobulin light chains. It is characterized by systemic deposition of light chains in various organs, with the kidneys being most commonly affected. There have been few reports of isolated LCDD, i.e. in the brain, lungs and cervical lymph nodes. We here report on another patient with an isolated form of LCDD, which was limited to the pharyngeal mucosa and was associated with an extraosseus plasmacytoma of the pharynx, expanding the spectrum that has been recognized for LCDD. The patient was treated by local radiotherapy, with an excellent response. A less aggressive clinical course can probably be expected than in the usual form of LCDD, but a long-term follow-up is necessary to establish the clinical significance of this variant of LCDD.
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Affiliation(s)
- Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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Jang ST, Sohn IS, Jin ES, Cho JM, Kim CJ, Lim SJ. A case of cardiac dysfunction associated with monoclonal gammopathy of undetermined significance. J Korean Med Sci 2009; 24:354-6. [PMID: 19399286 PMCID: PMC2672144 DOI: 10.3346/jkms.2009.24.2.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 06/26/2008] [Indexed: 11/24/2022] Open
Abstract
The monoclonal gammopathies (MG) are monoclonal neoplasms related to each other by virtue of their development from common progenitors in the B lymphocyte lineage. Cardiac dysfunction in patients with MG is not well established. We experienced a case of cardiac dysfunction associated with MG identified by echocardiography and biopsy. Fifty nine year-old man was admitted because of dyspnea for several months. Echocardiography revealed diastolic dysfunction showing restrictive physiology with elevated left ventricular filling pressure. Bone marrow (BM) studies and immunoelectrophoresis were compatible with monoclonal gammopathy of undetermined significance. Endomyocardial, BM, and enteral biopsies for ruling out for amyloidosis (Congo-red stain) were negative. This is the case of non-amyloidotic light chain deposition cardiomyopathy.
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Affiliation(s)
- Suk-Tae Jang
- Department of Cardiology, East-West Neo Medical Center of Kyunghee University, Seoul, Korea
| | - Il-Suk Sohn
- Department of Cardiology, East-West Neo Medical Center of Kyunghee University, Seoul, Korea
| | - Eun-Sun Jin
- Department of Cardiology, East-West Neo Medical Center of Kyunghee University, Seoul, Korea
| | - Jin-Man Cho
- Department of Cardiology, East-West Neo Medical Center of Kyunghee University, Seoul, Korea
| | - Chong-Jin Kim
- Department of Cardiology, East-West Neo Medical Center of Kyunghee University, Seoul, Korea
| | - Sung-Jig Lim
- Department of Pathology, East-West Neo Medical Center of Kyunghee University, Seoul, Korea
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Hassoun H, Flombaum C, D'Agati VD, Rafferty BT, Cohen A, Klimek VM, Boruchov A, Kewalramani T, Reich L, Nimer SD, Comenzo RL. High-dose melphalan and auto-SCT in patients with monoclonal Ig deposition disease. Bone Marrow Transplant 2008; 42:405-12. [DOI: 10.1038/bmt.2008.179] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fabbian F, Stabellini N, Sartori S, Tombesi P, Aleotti A, Bergami M, Uggeri S, Galdi A, Molino C, Catizone L. Light chain deposition disease presenting as paroxysmal atrial fibrillation: a case report. J Med Case Rep 2007; 1:187. [PMID: 18163912 PMCID: PMC2254633 DOI: 10.1186/1752-1947-1-187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 12/29/2007] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Light chain deposition disease (LCDD) can involve the heart and cause severe heart failure. Cardiac involvement is usually described in the advanced stages of the disease. We report the case of a woman in whom restrictive cardiomyopathy due to LCDD presented with paroxysmal atrial fibrillation. CASE PRESENTATION A 55-year-old woman was admitted to our emergency department because of palpitations. In a recent blood test, serum creatinine was 1.4 mg/dl. She was found to have high blood pressure, left ventricular hypertrophy and paroxysmal atrial fibrillation. An ACE-inhibitor was prescribed but her renal function rapidly worsened and she was admitted to our nephrology unit. On admission serum creatinine was 9.4 mg/dl, potassium 6.8 mmol/l, haemoglobin 7.7 g/dl, N-terminal pro-brain natriuretic peptide 29894 pg/ml. A central venous catheter was inserted and haemodialysis was started. She underwent a renal biopsy which showed kappa LCDD. Bone marrow aspiration and bone biopsy demonstrated kappa light chain multiple myeloma. Echocardiographic findings were consistent with restrictive cardiomyopathy. Thalidomide and dexamethasone were prescribed, and a peritoneal catheter was inserted. Peritoneal dialysis has now been performed for 15 months without complications. DISCUSSION Despite the predominant tubular deposition of kappa light chain, in our patient the first clinical manifestation of LCDD was cardiac disease manifesting as atrial fibrillation and the correct diagnosis was delayed. The clinical management initially addressed the cardiovascular symptoms without paying sufficient attention to the pre-existing slight increase in our patient's serum creatinine. However cardiac involvement is a quite uncommon presentation of LCDD, and this unusual case suggests that the onset of acute arrhythmias associated with restrictive cardiomyopathy and impaired renal function might be related to LCDD.
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Molina-Garrido MJ, Guillén-Ponce C, Mora A, Guirado-Risueño M, Molina MA, Molina MJ, Carrato A. Deposition-associated diseases related with a monoclonal compound. Clin Transl Oncol 2007; 9:777-83. [PMID: 18158981 DOI: 10.1007/s12094-007-0139-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Up to 3% of adults over 50 years of age show a monoclonal peak values in blood or urine. Findings and prognosis will be distinct in view of the nature of this factor. In B-cell neoplasias (multiple myeloma, Waldeström macroglobulinaemia, chronic myeloid leukaemia and non-Hodgkin lymphoma) the clinical pattern is dominated by the systemic effects produced by the expansion of the malign clone; the monoclonal protein may result in hyperviscosity syndrome or renal damage. On the other hand, there are other less frequent processes called diseases associated to monoclonal components, where the main clinical manifestations and prognosis depend of the biological effects of the monoclonal protein. With reference to this last group, which is the objective of this revision, no bone lesions, anaemia or a greater tendency to infections usually occur when compared with the first group. Even so, there are some cases of interposition between both groups: for instance, type IgM immunoglobulin present in Waldeström macroglobulinaemia may have cold agglutinin activity, and in the case of multiple myeloma, the clone may secrete amyloidogenic light chains.
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Affiliation(s)
- M J Molina-Garrido
- Oncology Department, General Universitary Hospital in Elche, Elche, Alicante, Spain.
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Abstract
The amyloidoses are a group of disorders in which soluble proteins aggregate and deposit extracellularly in tissues as insoluble fibrils, causing progressive organ dysfunction. The kidney is one of the most frequent sites of amyloid deposition in AL, AA, and several of the hereditary amyloidoses. Amyloid fibril formation begins with the misfolding of an amyloidogenic precursor protein. The misfolded variants self-aggregate in a highly ordered manner, generating protofilaments that interact to form fibrils. The fibrils have a characteristic appearance by electron microscopy and generate birefringence under polarized light when stained with Congo red dye. Advances in elucidating the mechanisms of amyloid fibril formation, tissue deposition, and tissue injury have led to new and more aggressive treatment approaches for these disorders. This article reviews the pathogenesis, diagnosis, clinical manifestations, and treatment of the amyloidoses, focusing heavily on the renal aspects of each of these areas.
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Affiliation(s)
- Laura M Dember
- Renal Section, Boston University School of Medicine, EBRC 504, 650 Albany Street, Boston, MA 02118, USA.
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