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Kozicka UA, Kożuch K, Sadowski K, Gupta T, Hoffman P, Szymański P, Kowalski M, Lipczyńska M. Long-term myocardial performance of the systemic right ventricle during exercise in patients with transposition of the great arteries and atrial switch operation. Hellenic J Cardiol 2024:S1109-9666(24)00174-X. [PMID: 39128709 DOI: 10.1016/j.hjc.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/22/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024] Open
Abstract
The most common clinical scenario in which RV is systemic, is dextroposition transposition of the great arteries (dTGA). This is the second most common cyanotic congenital heart disease [2]. Before the arterial switch operation was introduced in 1975 [3], patients with dTGA were treated with the Mustard or Senning procedure, also referred to as the atrial switch operation, where the systemic veins are routed to the subpulmonary morphological left ventricle and the pulmonary veins are routed to the systemic right ventricle [4].The atrial switch operation leaves the RV in a systemic position, leading to gradual RV dysfunction and RV failure [5-8]. In this context, sRV functional reserve and its ability to augment performance with exercise performance is not well studied.
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Affiliation(s)
- Urszula Alicja Kozicka
- Clinical Cardiology Centre, National Medical Institute of the Interior and Administration, Warsaw, Poland
| | | | - Krzysztof Sadowski
- Department of Coronary Artery Disease and Cardiac Rehabilitation, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Tripti Gupta
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Piotr Hoffman
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology,Warsaw, Poland
| | - Piotr Szymański
- Clinical Cardiology Centre, National Medical Institute of the Interior and Administration, Warsaw, Poland; Center of Postgraduate Medical Education, Warsaw, Poland
| | - Mirosław Kowalski
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology,Warsaw, Poland
| | - Magdalena Lipczyńska
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology,Warsaw, Poland
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Ostler H, Liu L, Tong K, Acuero MT, Gomez-Arostegui J, Degner S, Choo S, Golding F, Hegde S, Kuo DJ, Narayan HK. Feasibility, reproducibility, and accuracy of echocardiographic right ventricular systolic function assessments in childhood cancer survivors at risk for heart failure. Echocardiography 2024; 41:e15905. [PMID: 39158961 PMCID: PMC11338588 DOI: 10.1111/echo.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/26/2024] [Accepted: 08/04/2024] [Indexed: 08/20/2024] Open
Abstract
PURPOSE We sought to assess the feasibility, reproducibility, and accuracy of conventional and newer echocardiographic measures of right ventricular (RV) systolic function in adolescent and young adult childhood cancer survivors treated with anthracyclines. METHODS Echocardiography and cardiac magnetic resonance imaging (CMR) were acquired ≤60 days apart in prospectively recruited survivors and RV functional measures were quantitated by blinded observers. Repeat quantitation was performed in a subset to evaluate reproducibility. For each echocardiographic measure, Spearman correlations with CMR measures were calculated, and values in participants with CMR RV ejection fraction (RVEF) ≥48% and RVEF <48% were compared using two sample Wilcoxon rank-sum tests. RESULTS Among 58 participants, mean age was 18.2 years (range 13.1-25.2) and five participants had CMR RVEF <48%. Intra- and inter-observer coefficients of variation were 8.2%-10.1% and 10.5%-12.0% for adjusted automated strain measures, and 5.2%-8.7% and 2.7% for 3D RVEF, respectively. No echocardiographic measures were significantly correlated with CMR RVEF; only tricuspid annular plane systolic excursion was correlated with CMR RV stroke volume (r = .392, p = .003). Participants with RV dysfunction had worse automated global longitudinal strain (-20.3% vs. -23.9%, p = .007) and free wall longitudinal strain (-23.7% vs. -26.7%, p = .09). CONCLUSIONS Echocardiographic strain and 3D RV function measurements were feasible and reproducible in at-risk childhood cancer survivors. Although not associated with CMR RVEF in this population with predominantly normal RV function, automated strain measurements were more abnormal in participants with RV dysfunction, suggesting potential clinical utility of these measures.
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Affiliation(s)
- Heidi Ostler
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Lin Liu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA
| | - Khang Tong
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla, CA
| | - Maria T. Acuero
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Juliana Gomez-Arostegui
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Seth Degner
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Sun Choo
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Fraser Golding
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Sanjeet Hegde
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Dennis J. Kuo
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
| | - Hari K. Narayan
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Rady Children’s Hospital San Diego, San Diego, CA
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Behavior of echocardiographic parameters of right ventricular function after tricuspid surgery. Sci Rep 2022; 12:19447. [PMID: 36376476 PMCID: PMC9663697 DOI: 10.1038/s41598-022-24048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Evaluation of right ventricular (RV) function after tricuspid valve surgery is complex. The objective was to identify the most appropriate RV function parameters for this purpose. This prospective study included 70 patients undergoing cardiac and tricuspid valve (TV) surgery. RV size and function parameters were determined at 3 months and 1-year post-surgery. Categorical variables were analyzed with the McNemar test and numerical variables with the Student's t-test for related samples or, when non-normally distributed, the Wilcoxon test. Spearman's rho was used to determine correlations between variables at 3 months and 1 year. RV diameters were reduced at 3 months post-surgery and were then unchanged at 1 year. Tricuspid annular plane systolic excursion (TAPSE) and S' wave values were worse at 3 months and then improved at 1 year (t-score-2.35, p 0.023; t-score-2.68; p 0.010). There was no significant reduction in free wall longitudinal strain (LS) or shortening fraction (SF) at 3 months (t-score 1.421 and - 1.251; p 0.218 and 0.172), and they were only slightly below pre-surgical values at 1 year. No relationship was found between RV function parameters and mortality or major complications. During the first few months after TV surgery, LS may be a more appropriate parameter to evaluate global ventricular function in comparison to TAPSE. At 1 year, good correlations are observed between TAPSE, S' wave, and LS values.
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Scorza R, Shahgaldi K, Rosenqvist M, Frykman V. Evaluation of patients with high burden of premature ventricular contractions by comprehensive transthoracic echocardiography. IJC HEART & VASCULATURE 2022; 42:101124. [PMID: 36161233 PMCID: PMC9489744 DOI: 10.1016/j.ijcha.2022.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022]
Abstract
Background The prevalence and prognosis of premature ventricular contractions (PVCs) among individuals without structural heart disease are uncertain. Standard transthoracic echocardiography is a common method in evaluation of underlying cardiovascular disease and is recommended as a diagnostic method in PVC patients. However, it is unclear whether comprehensive echocardiographic examination can identify pathological findings in PVC patients with a normal standard echocardiogram. Method We included forty consecutive patients with a high PVC burden (>10,000 PVCs/day) and normal findings at a standard echocardiogram and exercise test. All subjects were investigated by a comprehensive echocardiographic examination using parameters usually not included in a routine work-up. We compared the results with 22 age and sex-matched controls. Results In six additional parameters-global longitudinal strain, right ventricular strain, septal-lateral delay, ventricular-arterial coupling, integrated backscatter and left atrial activation time-a statistically significant difference was shown between PVC patients and controls. Among these parameters, global longitudinal strain had a high reliability between operators. Conclusions Despite normal findings at standard echocardiography, the PVC group showed signs of impaired heart function when more comprehensive echocardiography parameters were used.
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Affiliation(s)
- Raffaele Scorza
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
- Deparment of Cardiology and Clinical Physiology, Danderyd University Hospital, Stockholm, Sweden
| | - Kambiz Shahgaldi
- Deparment of Cardiology and Clinical Physiology, Danderyd University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Sciences, Cardiovascular Unit, Danderyd University Hospital, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Sciences, Cardiovascular Unit, Danderyd University Hospital, Stockholm, Sweden
| | - Viveka Frykman
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Sciences, Cardiovascular Unit, Danderyd University Hospital, Stockholm, Sweden
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Espinola-Zavaleta N, Antonio-Villa NE, Guerra EC, Nanda NC, Rudski L, Alvarez-Santana R, Camacho-Camacho G, Aranda-Fraustro A, Cossio-Aranda J, Zamora K, Oregel-Camacho D, Armenta-Moreno JI, Berarducci J, Alexanderson-Rosas E. Right Heart Chambers Longitudinal Strain Provides Enhanced Diagnosis and Categorization in Patients With Pulmonary Hypertension. Front Cardiovasc Med 2022; 9:841776. [PMID: 35433867 PMCID: PMC9008240 DOI: 10.3389/fcvm.2022.841776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increased systolic pulmonary arterial pressure (sPAP) could lead to the mechanical dysfunction and myocardial fibrosis of the right heart chambers. Echocardiographic strain analysis has not been adequately studied in patients with pulmonary hypertension (PH). Study design and methods A cross-sectional cohort of patients with suspected PH and echocardiographic strain evaluation was recruited. The cut-off values of peak tricuspid regurgitation velocity (TRV) with the low probability of PH (≤2.8 m/s), intermediate probability (2.9-3.4 m/s, without other echo PH signs), and high probability of PH (2.9-3.4 m/s with other echo PH signs and >3.4 m/s) categories were studied by right ventricular and right atrial (RA) strain analysis in a sample of 236 patients. Results The results showed that 58 (56.9%) patients had low, 15 (14.7%) had intermediate, and 29 (28.4%) had a high probability of PH. We observed a negative association between right ventricular free wall strain (RV-FWS) and atrial global strain with sPAP. With the increase in PH severity, RA reservoir, conduit, and contraction (booster) strain values decreased. The identified cut-off values of strain parameters had an adequate ability to detect PH severity categories. In addition, the post-mortem biopsies of right heart chambers from subjects with known severe PH were analyzed to quantify myocardial fibrosis. Our sample of right heart biopsies (n = 12) demonstrated an association between increased sPAP before death and right ventricular and RA fibrosis. Conclusion Mechanical dysfunction and fibrosis in the right chambers are associated with increased sPAP. Right ventricular and atrial strain could provide enhancement in the diagnosis and categorization of subjects with suspected PH.
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Affiliation(s)
- Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Department of Echocardiography, The American British Cowdray Medical Center, Private Assistance Institution, Mexico City, Mexico
| | | | - Enrique C. Guerra
- MD/Ph.D. (PECEM) Program, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Navin C. Nanda
- Division of Cardiology, Department of Medicine, University of Alabama, Birmingham, AL, United States
| | - Lawrence Rudski
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ricardo Alvarez-Santana
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Gyssele Camacho-Camacho
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Inter-Institutional Program for Strengthening Research and Postgraduate Studies in the Pacific (Dolphin), Mexico City, Mexico
| | - Alberto Aranda-Fraustro
- Department of Pathology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Jorge Cossio-Aranda
- Out-Patient Clinic, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Karina Zamora
- Out-Patient Clinic, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Diego Oregel-Camacho
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Inter-Institutional Program for Strengthening Research and Postgraduate Studies in the Pacific (Dolphin), Mexico City, Mexico
| | | | - Joaquin Berarducci
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Department of Physiology, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Ji M, Wu W, He L, Gao L, Zhang Y, Lin Y, Qian M, Wang J, Zhang L, Xie M, Li Y. Right Ventricular Longitudinal Strain in Patients with Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12020445. [PMID: 35204536 PMCID: PMC8871506 DOI: 10.3390/diagnostics12020445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenqian Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanting Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingzhu Qian
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
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Echocardiographic Strain Imaging in the Systemic Right Ventricle: Early Clue for Late Decompensation. Can J Cardiol 2020; 36:1341-1343. [PMID: 32569595 DOI: 10.1016/j.cjca.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/23/2022] Open
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