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Lazarou E, Vlachopoulos C, Antonopoulos A, Imazio M, Brucato A, Tsioufis C, Lazaros G. Asymptomatic Chronic Large Pericardial Effusions: To Drain or to Observe? J Clin Med 2024; 13:3887. [PMID: 38999452 PMCID: PMC11242720 DOI: 10.3390/jcm13133887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/09/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Pericardial effusions, especially large ones, have traditionally been regarded with concern by clinicians due to the sometimes unpredictable development of life-threatening cardiac tamponade. In the European Society of Cardiology Guidelines on pericardial diseases, the simplified algorithm for pericardial effusion triage and management recommends pericardial drainage in cases of cardiac tamponade and/or suspicion of bacterial or neoplastic etiology. In the presence of acute pericarditis, empiric anti-inflammatory treatment should be given, while when a specific indication known to be associated with pericardial effusion is found, then treatment of the underlying cause is indicated. Notably, the most challenging subgroup of patients includes those with large, asymptomatic, C-reactive-protein-negative, idiopathic effusions. In the latter subjects, pericardial drainage is proposed in cases of chronic effusions (lasting more than three months). However, this recommendation is based on scant data stemming from small-sized non-randomized studies. Nevertheless, recent evidence in a larger cohort of patients pointed out that a watchful waiting strategy is a safe option in terms of complication-free survival. This review summarizes the contemporary evidence on this challenging topic and provides recommendations for tailoring individual patient treatments.
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Affiliation(s)
- Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - Alexios Antonopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - Massimo Imazio
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy;
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, 33100 Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy;
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
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Sahiti F, Cejka V, Schmidbauer L, Albert J, Kerwagen F, Frantz S, Gelbrich G, Heuschmann PU, Störk S, Morbach C. Prognostic Utility of Pericardial Effusion in the General Population: Findings From the STAAB Cohort Study. J Am Heart Assoc 2024; 13:e035549. [PMID: 38879452 PMCID: PMC11255739 DOI: 10.1161/jaha.124.035549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND The incidental finding of a pericardial effusion (PE) poses a challenge in clinical care. PE is associated with malignant conditions or severe cardiac disease but may also be observed in healthy individuals. This study explored the prevalence, determinants, course, and prognostic relevance of PE in a population-based cohort. METHODS AND RESULTS The STAAB (Characteristics and Course of Heart Failure Stages A/B and Determinants of Progression) cohort study recruited a representative sample of the population of Würzburg, aged 30 to 79 years. Participants underwent quality-controlled transthoracic echocardiography including the dedicated evaluation of the pericardial space. Of 4965 individuals included at baseline (mean age, 55±12 years; 52% women), 134 (2.7%) exhibited an incidentally diagnosed PE (median diameter, 2.7 mm; quartiles, 2.0-4.1 mm). In multivariable logistic regression, lower body mass index and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were associated with PE at baseline, whereas inflammation, malignancy, and rheumatoid disease were not. Among the 3901 participants attending the follow-up examination after a median time of 34 (30-41) months, PE was found in 60 individuals (1.5%; n=18 new PE, n=42 persistent PE). Within the follow-up period, 37 participants died and 93 participants reported a newly diagnosed malignancy. The presence of PE did not predict all-cause death or the development of new malignancy. CONCLUSIONS Incidental PE was detected in about 3% of individuals, with the vast majority measuring <10 mm and completely resolving. PE was not associated with inflammation markers, death, incident heart failure, or malignancy. Our findings corroborate the view of current guidelines that a small PE in asymptomatic individuals can be considered an innocent phenomenon and does not require extensive short-term monitoring.
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Affiliation(s)
- Floran Sahiti
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Vladimir Cejka
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
| | - Lena Schmidbauer
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Judith Albert
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Fabian Kerwagen
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Stefan Frantz
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Götz Gelbrich
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Peter U. Heuschmann
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
- Institute of Medical Data ScienceUniversity Hospital WurzburgGermany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Caroline Morbach
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
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Palicherla A, Torres R, Walters RW, Thandra A, Narmi A, Smer A. Outcomes of Valvular Endocarditis in Patients With and Without Pericardial Effusion: A National Inpatient Sample Study. Curr Probl Cardiol 2023; 48:101863. [PMID: 37301489 DOI: 10.1016/j.cpcardiol.2023.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Over the last decade, hospitalizations for infective endocarditis (IE) have been steadily increasing, leading to a significant healthcare burden. Pericardial effusion (PCE) has been identified as a serious complication of IE, yet no significant association with mortality has been established. Our study aims to further analyze and understand the significance of PCE in patients with IE. We performed a retrospective analysis using the national inpatient sample database to identify all the hospital admissions with IE using ICD 10 codes and stratified them into 2 groups based on the presence of PCE. The outcomes of interest were inhospital mortality, inhospital complications, need for cardiac surgery, and length of stay. From 2015 Q4-2019, a total of 76,260 hospitalizations were included (weighted: 381,300), of which 2.7% included a PCE diagnosis. Hospitalizations with a PCE diagnosis included patients that were younger (51 vs 61, P < 0.001), as well as slightly more males (58.0% vs 55.2%, P = 0.011), and black patients (16.9% vs 12.9%, P < 0.001). PCE was associated with higher in-hospital death (12.7% vs 9.0%, P < 0.001), longer lengths of stay (12 days vs 7 days, P < 0.001), higher rates of cardiac surgery (22.4% vs 7.3%, P < 0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher on PCE group. We found that presence of PCE is associated with higher inhospital mortality, longer length of stay, and greater utilization of cardiac surgery, as well as presence of heart failure, heart block, cardiogenic shock, and embolic stroke.
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Affiliation(s)
- Anirudh Palicherla
- Department of Medicine, Creighton University School of Medicine, Omaha, NE.
| | - Rosa Torres
- Department of Medicine, Creighton University School of Medicine, Omaha, NE
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE
| | - Abhishek Thandra
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Ann Narmi
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Aiman Smer
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE
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Hoit BD. Pericardial Effusion and Cardiac Tamponade Pathophysiology and New Approaches to Treatment. Curr Cardiol Rep 2023; 25:1003-1014. [PMID: 37515704 DOI: 10.1007/s11886-023-01920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE OF REVIEW The objective of this manuscript is to examine up-to-date approaches to the diagnosis and treatment of pericardial effusions and cardiac tamponade. RECENT FINDINGS Recent recommendations from the American Society of Echocardiography and the European Society of Cardiology have improved our management of the patient with pericardial effusion and cardiac tamponade, but significant knowledge gaps remain. Novel diagnostic and triage strategies have been suggested, and recent information have improved our facility to assess the presence and size of a pericardial effusion, assess its hemodynamic impact, and determine its cause. Despite these recent findings, there is a scarcity of evidence-based data to direct the management of pericardial effusion and cardiac tamponade. While the first-line function of echocardiography in managing these disorders is undisputed, there are increasingly niche functions for multimodality imaging.
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Affiliation(s)
- Brian D Hoit
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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5
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Lazaros G, Imazio M, Tsioufis P, Lazarou E, Vlachopoulos C, Tsioufis C. Chronic Pericardial Effusion: Causes and Management. Can J Cardiol 2023; 39:1121-1131. [PMID: 36773704 DOI: 10.1016/j.cjca.2023.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Chronic pericardial effusion is a common pericardial syndrome whose approach has been well standardised in recent years. The main challenge associated with this condition is the progression (sometimes unheralded) to cardiac tamponade. Pericardial effusions may present either as an isolated finding or in the context of a specific etiology including autoimmune, neoplastic, or metabolic disease. Among investigations used during diagnostic work-up, echocardiography is of paramount importance for the diagnosis, sizing, and serial evaluation of the hemodynamic impact of effusions on heart diastolic function. In an individualised manner, advanced imaging including computed tomography and cardiac magnetic resonance imaging should be performed, especially if baseline tests are inconclusive. Triage of these patients according to the most recent 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial diseases should take into account the presence of hemodynamic compromise as well as suspicion of malignant or purulent pericarditis as first step, C-reactive protein serum level measurement as second step, investigations for a specific condition known to be associated with pericardial effusion as third step, and finally the size and the duration of the effusion. Treatment depends on the evaluation of the above-mentioned parameters and should ideally be tailored to the individual patient. Prognosis of chronic pericardial effusions depends largely on the underlying etiology. According to novel data, the prognosis of individuals with idiopathic, chronic (> 3 months), large (> 2 cm), asymptomatic pericardial effusions is usually benign and a watchful waiting strategy seems more reasonable and cost-effective than routine drainage as previously recommended.
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Affiliation(s)
- George Lazaros
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Panagiotis Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Siwik D, Apanasiewicz W, Żukowska M, Jaczewski G, Dąbrowska M. Diagnosing Lung Abnormalities Related to Heart Failure in Chest Radiogram, Lung Ultrasound and Thoracic Computed Tomography. Adv Respir Med 2023; 91:103-122. [PMID: 36960960 PMCID: PMC10037625 DOI: 10.3390/arm91020010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 03/25/2023]
Abstract
Heart failure (HF) is a multidisciplinary disease affecting almost 1-2% of the adult population worldwide. Symptoms most frequently reported by patients suffering from HF include dyspnoea, cough or exercise intolerance, which is equally often observed in many pulmonary diseases. The spectrum of lung changes related to HF is wide. The knowledge of different types of these abnormalities is essential to distinguish patients with HF from patients with lung diseases or both disorders and thus avoid unnecessary diagnostics or therapies. In this review, we aimed to summarise recent research concerning the spectrum of lung abnormalities related to HF in three frequently used lung imaging techniques: chest X-ray (CXR), lung ultrasound (LUS) and chest computed tomography (CT). We discussed the most prevalent abnormalities in the above-mentioned investigations in the context of consecutive pathophysiological stages identified in HF: (i) redistribution, (ii) interstitial oedema, and (iii) alveolar oedema. Finally, we compared the utility of these imaging tools in the clinical setting. In conclusion, we consider LUS the most useful and promising imaging technique due to its high sensitivity, repeatability and accessibility. However, the value of CXR and chest CT is their potential for establishing a differential diagnosis.
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Affiliation(s)
- Dominika Siwik
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Wojciech Apanasiewicz
- Students' Research Group 'Alveolus', Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Małgorzata Żukowska
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Grzegorz Jaczewski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marta Dąbrowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
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Chashchin MG, Gorshkov AY, Drapkina OM, Kositsyna IV, Golubev AV, Chaus NI, Perekhodov SN. [Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19]. KARDIOLOGIIA 2022; 62:18-26. [PMID: 35692170 DOI: 10.18087/cardio.2022.5.n2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
Aim To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.
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Affiliation(s)
- M G Chashchin
- National Medical Research Center for Therapy and Preventive Medicine, Moscow; Demikhov Municipal Clinical Hospital, Moscow
| | - A Yu Gorshkov
- National Medical Research Center for Therapy and Preventive Medicine, Moscow
| | - O M Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Moscow
| | - I V Kositsyna
- Demikhov Municipal Clinical Hospital, Moscow; Evdokimov Moscow State University of Medicine and Dentistry, Moscow
| | - A V Golubev
- City Clinical Hospital named after V.P.Demikhov Moscow Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - N I Chaus
- Demikhov Municipal Clinical Hospital, Moscow; Russian Medical Academy of Continuous Professional Education, Moscow
| | - S N Perekhodov
- Demikhov Municipal Clinical Hospital, Moscow; Evdokimov Moscow State University of Medicine and Dentistry, Moscow
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Lazaros G, Lazarou E, Tsioufis P, Soulaidopoulos S, Iliakis P, Vlachopoulos C, Tsioufis C. Chronic pericardial effusion: current concepts and emerging trends. Expert Rev Cardiovasc Ther 2022; 20:363-376. [PMID: 35524164 DOI: 10.1080/14779072.2022.2075346] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pericardial effusion (PEF) is a common and challenging pericardial syndrome with a variety of clinical manifestations ranging from asymptomatic, incidentally uncovered small PEFs, to life-threatening cardiac tamponade. AREAS COVERED : This review focuses on the pathophysiology, epidemiology, etiology, classification, clinical findings, diagnostic work-up, management and outcome of PEFs. Particular emphasis has been given on the most recent evidence concerning the contribution of imaging for the detection, differential diagnosis and evaluation of the hemodynamic impact of PEFs on the diastolic filling of the heart. Moreover, simplified algorithms for PEF triage and management have been included. EXPERT OPINION The management of patients with PEFs is mainly based on four parameters namely hemodynamic impact on diastolic function, elevation of inflammatory markers, presence of a specific underlying condition known to be associated with PEF and finally size and duration of the effusion. Novel data have contributed to change our view towards large, asymptomatic, "idiopathic" PEFs and dictated a rather conservative approach in most cases. It is also stressed that there is a compelling need for additional research, which is essential for tailored treatments aiming at the improvement of quality of life and containment of health care costs.
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Affiliation(s)
- George Lazaros
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Emilia Lazarou
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagιotis Iliakis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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10
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Timing of pericardiocentesis and clinical outcomes: Is earlier pericardiocentesis better? Am J Emerg Med 2022; 54:202-207. [DOI: 10.1016/j.ajem.2022.01.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/14/2022] [Accepted: 01/28/2022] [Indexed: 11/19/2022] Open
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Bizzi E, Picchi C, Mastrangelo G, Imazio M, Brucato A. Recent advances in pericarditis. Eur J Intern Med 2022; 95:24-31. [PMID: 34556390 DOI: 10.1016/j.ejim.2021.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
Pericardial diseases are an heterogeneous group of entities, ranging from acute pericarditis to asymptomatic pericardial effusions. New advances in understanding the processes underlying them have been made. In 2020 a prospective study defined the reference intervals of the component of normal pericardial fluid, that was found to be rich in nucleated cells, proteins, albumin and LDH, at levels compatible with the inflammatory exudates of other biological fluids such as pleural or peritoneal fluid; Light's criteria should not be used to evaluate it. Recently we also analyzed systematically large chronic idiopathic non-inflammatory pericardial effusions, observing that a non-invasive wait-and-see approach may be the best choice in clinical practice in oligosymptomatic cases. Concerning acute recurrent pericarditis (RP), an innovative interaction between cardiologists, internists and pediatric rheumatologists led to the intuition of a pivotal role of IL-1 in recurrent pericarditis characterized by an evident inflammatory recurrent phenotype, and recent data have shown the striking efficacy of anakinra and rilonacept in these patients. The proper selection of the patient is important; the ideal candidate for anti-IL-1 therapy is the patient with RP with high levels of serum C-reactive protein, high fever, neutrophil leukocitosis, pleuropulmonary involvement, frequent exacerbations and resistant to conventional therapy. On the contrary, anti-IL-1 drugs are not indicated in patients with pericardial effusion whose cause is not attributable to inflammatory phenomena. Finally, many patients with RP are women of childbearing age, and the possibility for these women to become pregnant must be addressed by multidisciplinary teams.
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Affiliation(s)
- Emanuele Bizzi
- Internal Medicine Department, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Chiara Picchi
- Internal Medicine Department, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Greta Mastrangelo
- Department of Pediatrics, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Antonio Brucato
- University of Milano, Department of biomedical and clinical sciences "Luigi Sacco", Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
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Pennacchioni A, Nanni G, Sgura FA, Imberti JF, Monopoli DE, Rossi R, Longo G, Arrotti S, Vitolo M, Boriani G. Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes. Intern Emerg Med 2021; 16:1771-1777. [PMID: 33616878 PMCID: PMC7898017 DOI: 10.1007/s11739-021-02642-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022]
Abstract
Pericardial effusion can dangerously precipitate patient's hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010-2019). We enrolled 81 consecutive patients. Median age was 71.4 years (interquartile range [IQR] 58.1-78.1 years) and 51 (63%) were male. Most of the pericardiocentesis were performed in an urgency setting (76.5%) for cardiac tamponade (77.8%). The most common etiology was idiopathic (33.3%) followed by neoplastic (22.2%). In-hospital mortality was 14.8% while mortality during follow-up (mean 17.1 months) was 44.4%. Only hemodynamic instability (i.e., cardiogenic shock, hypotension refractory to fluid challenge therapy and inotropes) was associated with in-hospital mortality at the univariate analysis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.76-29.4). Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65-20.01, and OR 5.81, 95% CI 2.11-15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45-11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.
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Affiliation(s)
- Andrea Pennacchioni
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giulia Nanni
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Daniel Enrique Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Rosario Rossi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giuseppe Longo
- Oncology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy.
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Abstract
Purpose of Review Pericardial effusion is a challenging pericardial syndrome and a cause of serious concern for physicians and patients due to its potential progression to life-threatening cardiac tamponade. In this review, we summarize the contemporary evidence of the etiology; diagnostic work-up, with particular emphasis on the contribution of multimodality imaging; therapeutic options; and short- and long-term outcomes of these patients. Recent Findings In recent years, an important piece of information has contributed to put together several missing parts of the puzzle of pericardial effusion. The most recent 2015 guidelines of the European Society of Cardiology for the diagnosis and management of pericardial diseases are a valuable aid for a tailored approach to this condition. Actually, current guidelines suggest a 4-step treatment algorithm depending on the presence or absence of hemodynamic impairment; the elevation of inflammatory markers; the presence of a known or first-diagnosed underlying condition, possibly related to pericardial effusion; and finally the duration and size of the effusion. In contrast to earlier perceptions, based on the most recent evidence, it seems that in the subgroup of asymptomatic patients with large (> 2-cm end-diastolic diameter), chronic (> 3 months) C-reactive protein negative, idiopathic (without an apparent cause) pericardial effusion, a conservative approach is the most reasonable option. Summary At present there is an increasing interest in the pericardial syndromes in general and pericardial effusions in specific, which has consistently expanded our knowledge in this “hazy landscape.” Apart from general recommendations applied to all cases, an individualized, etiologically driven treatment is of paramount importance.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
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Albani S, Fabris E, Stolfo D, Falco L, Barbati G, Aquaro GD, Vitrella G, Rakar S, Korcova R, Lardieri G, Giannini F, Perkan A, Sinagra G. Prognostic relevance of pericardial effusion in STEMI patients treated by primary percutaneous coronary intervention: a 10-year single-centre experience. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:71–80. [PMID: 31696727 DOI: 10.1177/2048872619884858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/07/2019] [Indexed: 02/24/2024]
Abstract
BACKGROUND Pericardial effusion is frequent in the acute phase of ST-segment elevation myocardial infarction. However, its prognostic role in the era of primary percutaneous coronary intervention is not completely understood. METHODS We investigated the association between pericardial effusion, assessed by transthoracic echocardiography, and survival in a large cohort of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention, enrolled in the Trieste primary percutaneous coronary intervention registry from January 2007 to March 2017. Multivariable analysis and a propensity score approach were performed. RESULTS A total of 1732 ST-segment elevation myocardial infarction patients were included. Median follow-up was 45 (interquartile range 19-79) months. Pericardial effusion was present in 246 patients (14.2%). Thirty-day all-cause mortality was similar between patients with and without pericardial effusion (7.8% vs. 5.4%, P=0.15), whereas crude long-term survival was worse in patients with pericardial effusion (26.2% vs. 17.7%, P≤0.01). However, at multivariable analyses the presence of pericardial effusion was not associated with long-term mortality (hazard ratio 1.26, 95% confidence interval 0.86-1.82, P=0.22). Matching based on propensity scores confirmed the lack of association between pericardial effusion and both 30-day (hazard ratio 1, 95% confidence interval 0.42-2.36, P=1) and long-term (hazard ratio 1.14, 95% confidence interval 0.74-1.78, P=0.53) all-cause mortality. Patients with pericardial effusion experienced a higher incidence of free wall rupture (2.8% vs. 0.5%, P<0.0001) independently of the entity of pericardial effusion. CONCLUSIONS In acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, the onset of pericardial effusion after ST-segment elevation myocardial infarction is not independently associated with short and long-term higher mortality. Free wall rupture has to be considered rare compared to the fibrinolytic era and occurs more frequently in patients with pericardial effusion, suggesting a close monitoring of these patients in the early post-primary percutaneous coronary intervention phase.
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Affiliation(s)
- Stefano Albani
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Luca Falco
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | | | - Giancarlo Vitrella
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Serena Rakar
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Renata Korcova
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Gerardina Lardieri
- Department of Cardiology, Azienda per l'Assistenza Sanitaria n 2 Bassa Friulana-Isontina, Gorizia, Italy
| | - Francesco Giannini
- Department of Cardiology, Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Ravenna, Italy
| | - Andrea Perkan
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
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Lazaros G, Vlachopoulos C, Lazarou E, Tousoulis D, Tsioufis C. Contemporary management of pericardial effusion. Panminerva Med 2021; 63:288-300. [PMID: 33393752 DOI: 10.23736/s0031-0808.20.04197-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericardial effusion is a relatively common clinical condition with a variety of clinical manifestations ranging from incidentally discovered asymptomatic cases to life-threatening cardiac tamponade. The etiology encompasses idiopathic cases and forms secondary to different conditions, including autoimmune diseases, malignancies, metabolic disorders, etc. While medical therapy should be offered to patients with elevation of inflammatory markers, in specific forms treatment should be appropriate to the underlying disorder. In cases with hemodynamic compromise pericardial drainage either with pericardiocentesis or pericardial "window" is indicated for therapeutic and diagnostic purposes. In the remainder, factors like comorbidities, size and location of the pericardial effusion will influence the clinical decision making. In asymptomatic or minimally symptomatic chronic large idiopathic pericardial effusions, according to recent evidence, a conservative approach with watchful waiting seems the most reasonable option. The prognosis of pericardial effusions largely depends on the underlying etiologies. Metastatic spread to the pericardium has an ominous prognosis whereas large to moderate effusions have been often associated with known or newly discovered specific underlying causes. Chronic small idiopathic effusions have an excellent prognosis and do not require specific monitoring. Large chronic idiopathic effusions in clinically stable patients require a 3 to 6-month assessment ideally in a specialized unit.
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Affiliation(s)
- George Lazaros
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece -
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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16
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Huang YS, Zhang JX, Sun Y. Chronic massive pericardial effusion: a case report and literature review. J Int Med Res 2020; 48:300060520973091. [PMID: 33233991 PMCID: PMC7705390 DOI: 10.1177/0300060520973091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic massive pericardial effusion without cardiac tamponade is relatively rare. Nearly half of all patients with chronic large pericardial effusion are asymptomatic. We report a case of a 77-year-old man who presented with an asymptomatic chronic massive pericardial effusion, with no evidence of cardiac tamponade or pericardial constriction during a 10-year follow-up. The patient had a complex history of lymph node tuberculosis, hypertension, hypothyroidism, and polycythemia vera, as well as high-dose 31P radiation exposure 45 years ago. There was no evidence of tuberculosis infection, hypothyroidism, malignant tumor, severe heart failure, uremia, trauma, severe bacterial or fungal infection, chronic myeloid leukemia, or bone marrow fibrosis after admission. The patient underwent pericardiocentesis twice. The pericardial effusion comprised exudate fluid with a high proportion of monocytes. The patient refused indwelling catheter drainage or pericardiectomy. The likely final diagnosis was recurrent chronic large idiopathic pericardial effusion.
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Affiliation(s)
- Ying-Shuo Huang
- Department of Research Ward, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian-Xiong Zhang
- Department of Research Ward, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Sun
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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17
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Abstract
PURPOSE OF REVIEW Abnormal accumulation of pericardial fluid is a common cardiac condition with different etiologies. Draining of the pericardial fluid (pericardiocentesis) is often indicated for diagnostic and therapeutic purposes and is performed in an elective or emergent setting. Echocardiography is the primary imaging method for diagnosing, localizing, and quantifying pericardial effusion as well as evaluating its hemodynamic effects, including the presence of cardiac tamponade. In this manuscript, we review the indications for pericardiocentesis and provide practical step-by-step guidance for echo-guided pericardiocentesis. RECENT FINDINGS Echo-guidance is an effective method to improve the safety and efficacy of pericardiocentesis. In experienced hands and with a stepwise approach, procedural outcomes are excellent, and complication rates are very low. Asymptomatic small idiopathic effusions have a benign course and can be left untreated. Prolonged drainage with an indwelling pericardial catheter is key for preventing fluid re-accumulation, and the use of colchicine to prevent fluid recurrence is encouraged whenever possible. Understanding how to evaluate the significance of a pericardial effusion as well as the procedural steps in the performance of a pericardiocentesis are essential for optimal outcomes in treating patients with pericardial effusions and tamponade.
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Affiliation(s)
- Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente, AHSP, Los Angeles, CA, 90048, USA.,Department of Cardiology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente, AHSP, Los Angeles, CA, 90048, USA.
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