European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Preventing Atrial Fibrillation with SGLT2 Inhibitors: Time, Sex, and Substrate.","authors":"Paschalis Karakasis, Antonios P Antoniadis, Nikolaos Fragakis","doi":"10.1093/ehjcvp/pvaf066","DOIUrl":"10.1093/ehjcvp/pvaf066","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term effectiveness of ACE inhibitors or angiotensin receptor blockers in myocardial infarction with preserved left ventricular ejection fraction.","authors":"Anna B C Humphreys, Bertil Lindahl, Anita Berglund, Vanessa Voelskow, Si Fang, Ole Fröbert, Robin Hofmann, Tomas Jernberg, Miguel A Hernán, Anthony A Matthews","doi":"10.1093/ehjcvp/pvaf051","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf051","url":null,"abstract":"<p><strong>Aims: </strong>Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are effective in the long-term treatment of myocardial infarction with reduced left ventricular ejection fraction (LVEF). However, it is unknown whether there is a benefit in myocardial infarction with preserved LVEF (≥50%).</p><p><strong>Methods and results: </strong>We used Swedish healthcare registries to emulate a target trial of ACEi/ARBs vs. no ACEi/ARBs for the prevention of a composite outcome (death, myocardial infarction, or heart failure) and its individual components among individuals under 75 years with myocardial infarction and LVEF ≥ 50% between September 2010 and June 2021. We estimated observational analogues of the intention-to-treat effect and the per-protocol effect with confounding adjustment via inverse probability weighting. The 10 697 individuals in the ACEi/ARB group were on average older (median 61 vs. 60 years) and more likely to be male (80.2% vs. 75.3% male) than the 4730 individuals in the no ACEi/ARB group. The estimated 5-year risk of the composite outcome was 7.8% (95% confidence interval 7.1%, 8.5%) in the ACEi/ARB group and 8.1% (7.0%, 9.3%) in the no ACEi/ARB group; risk difference -0.3% (-1.6%, 1.0%). After adjustment for adherence, the risk of the composite outcome was 6.5% (5.9%, 7.2%) in the ACEi/ARB group and 6.7% (5.6%, 8.1%) in the no ACEi/ARB group; risk difference -0.2% (-1.7%, 1.0%).</p><p><strong>Conclusion: </strong>The estimated risk of a composite of death, myocardial infarction or heart failure was similar in recipients and non-recipients of ACEi/ARB. Our estimates suggest ACEi/ARB treatment in myocardial infarction with preserved LVEF does not confer a benefit.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of rivaroxaban vs. apixaban in patients with atrial fibrillation and peripheral artery disease.","authors":"Loubna Dari, Sarah Beradid, Joël Constans, Antoine Pariente, Christel Renoux","doi":"10.1093/ehjcvp/pvaf063","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf063","url":null,"abstract":"<p><strong>Aims: </strong>To assess whether rivaroxaban is associated with a decreased risk of major adverse limb events (MALE), stroke, systemic embolism (SE), and major bleeding (MB) among patients with non-valvular atrial fibrillation (NVAF) and peripheral artery disease (PAD), compared with apixaban.</p><p><strong>Methods and results: </strong>We conducted a population-based cohort study using the UK Clinical Practice Research Datalink. Patients aged ≥45 years with incident NVAF and PAD who initiated rivaroxaban or apixaban between 2013 and 2021 were included. Primary effectiveness outcomes were MALE, and a composite of ischaemic stroke, transient ischaemic attack (TIA), or SE. The primary safety outcome was MB. The risk of major cardiovascular events (MACE) was assessed as a secondary outcome. Confounding was addressed using propensity score fine stratification and weighting. Weighted Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). The cohort included 6170 new users of rivaroxaban and 9990 new users of apixaban (44% female; mean [SD] age 78.5 [9.2] years). Incidence rates were similar for MALE (6.7 vs. 5.6/1000 person-years; adjusted HR (aHR): 1.20; 95% CI 0.87-1.65), stroke/TIA/SE (24.5 vs. 21.3/1000 person-years; aHR: 1.15; 95% CI 0.97-1.36), and MACE (40.1 vs. 35.9 per 1000 person-years; aHR 1.10: 95% CI 0.94-1.28). Major bleeding rates were higher with rivaroxaban (46.1 vs. 29.8/1000 person-years; aHR: 1.55; 95% CI 1.36-1.77).</p><p><strong>Conclusion: </strong>In patients with NVAF and PAD, rivaroxaban was associated with a similar risk of MALE and stroke/TIA/SE, but a higher risk of MB compared with apixaban. These findings support apixaban as a potentially safer anticoagulant in this high-risk population.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of early in-hospital initiation of sacubitril/valsartan on left ventricular reverse remodelling in acute heart failure.","authors":"Tomonori Takahashi, Kenya Kusunose, Takumi Imai, Yutaka Furukawa, Taiji Okada, Toshiaki Kadokami, Yumiko Kanzaki, Hisao Matsuda, Kei Mizukoshi, Keisuke Kida, Yuya Matsue, Masataka Sata, Atsushi Tanaka, Koichi Node","doi":"10.1093/ehjcvp/pvaf061","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf061","url":null,"abstract":"<p><strong>Aims: </strong>The effect of initiating sacubitril/valsartan (Sac/Val) therapy during hospitalization for acute heart failure (AHF) on left ventricular (LV) remodelling remains unclear. This study aimed to assess the impact of Sac/Val on LV remodelling in patients in whom Sac/Val was initiated during AHF hospitalization.</p><p><strong>Methods and results: </strong>This study was a sub-analysis of the Program of Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study, which investigated the impact of initiating Sac/Val during hospitalization for AHF on echocardiographic parameters over an 8-week period, in comparison with the standard renin-angiotensin system inhibitor therapy (control). Among the full analysis set of the PREMIER study, this analysis included 206 patients [mean age, 73 years; 64 females (31.1%)], who had available echocardiographic data. The Sac/Val group (n = 94) showed significantly improved LV function and morphological parameters at 8 weeks. Compared with the control group (n = 112), preload-dependent parameters improved significantly, including LV end-diastolic volume index [mean, -5.1 mL/m2; 95% confidence interval (CI), -10.2 to -0.04; P = 0.048] and tricuspid regurgitation peak velocity (mean, -0.17 m/s; 95% CI, -0.31 to -0.03; P = 0.016). In a subgroup analysis stratified by LV ejection fraction (LVEF), a reverse remodelling effect was primarily observed in patients with an LVEF < 40%.</p><p><strong>Conclusion: </strong>Early Sac/Val initiation after hospitalization for AHF may significantly improve LV function and morphology at 8 weeks, particularly in patients with an LVEF < 40%, supporting its role in LV reverse remodelling.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Glucagon-like Peptide-1 Receptor Agonists with Risk of Gastrointestinal Adverse Events: Evidence from A Drug Target Mendelian Randomization.","authors":"Hao-Zhang Huang, Jin Liu, Xiaozhao Lu, Ning Tan, Yong Liu","doi":"10.1093/ehjcvp/pvaf065","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf065","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril/valsartan and Quality of Life Assessed Using the EuroQol 5-Dimension 3-Level Questionnaire Level Sum Score (EQ-5D-3L-LSS) in Patients with HFrEF and HFmrEF/HFpEF.","authors":"Mingming Yang, Alasdair D Henderson, Inder S Anand, Akshay S Desai, Carolyn S P Lam, Aldo P Maggioni, Felipe A Martinez, Jean L Rouleau, Karl Swedberg, Muthiah Vaduganathan, Dirk J van Veldhuisen, Faiez Zannad, Michael R Zile, Milton Packer, Adel Rizkala, Eldrin F Lewis, Pardeep S Jhund, Scott D Solomon, John J V McMurray","doi":"10.1093/ehjcvp/pvaf064","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf064","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the EQ-5D-3L Level Sum Score (LSS) in patients with heart failure (HF) and reduced (HFrEF) and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and the effect of sacubitril/valsartan on this score using patient-level data from the PARADIGM-HF and PARAGON-HF trials.</p><p><strong>Methods: </strong>The LSS was calculated by summating the 3 levels (1-3) for each of the 5 domains (minimum sum score=5; maximum sum score=15). Patient characteristics and outcomes were compared across LSS tertiles (T1-T3) at baseline. Cox models were used to evaluate the primary endpoint (first HF hospitalization or cardiovascular death) according to tertiles of LSS. Changes in LSS severity at 8 months were analysed using ordinal logistic regression models to estimate the effect of sacubitril/valsartan versus enalapril or valsartan.</p><p><strong>Results: </strong>Of 13,195 patients, 12,974 had a baseline LSS. Compared to lower LSS, patients with higher (worse) scores were older, more often women and White, and had more comorbidities and more severe HF. At 8 months, patients assigned to sacubitril/valsartan experienced more improvement and less worsening of LSS versus the comparator: OR:1.16 (95%CI: 1.08-1.24). Sacubitril/valsartan also reduced the risk of the primary outcome across LSS tertiles: T1: HR: 0.87 (95%CI: 0.75-1.00); T2: 0.80 (95%CI: 0.71-0.90); T3: 0.87 (95%CI: 0.77-0.97); Pinteraction=0.59. Higher LSS was independently associated with a greater risk of the primary endpoint, and the achieved LSS at 8 months may be more strongly associated with subsequent outcomes.</p><p><strong>Conclusions: </strong>Sacubitril/valsartan significantly reduced the risk of HF events and improved health status across the LSS spectrum in HFrEF and HFmrEF/HFpEF.</p><p><strong>Clinical trial registration: </strong>https://www.clinicaltrials.gov. Unique identifiers: NCT01920711 (PARAGON-HF), NCT01035255 (PARADIGM-HF).</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-inflammatory pharmacotherapy in patients with cardiovascular disease.","authors":"Simone Finocchiaro, Placido Maria Mazzone, Nicola Ammirabile, Costanza Bordonaro, Carmelo Cusmano, Luigi Cutore, Giacinto Di Leo, Denise Cristiana Faro, Daniele Giacoppo, Antonio Greco, Antonino Imbesi, Maria Sara Mauro, Carmelo Raffo, Marco Spagnolo, Davide Capodanno","doi":"10.1093/ehjcvp/pvaf058","DOIUrl":"10.1093/ehjcvp/pvaf058","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality. In addition to traditional risk factors, inflammation is established as a key mechanism in the initiation, progression, and complications of CVD. Elevated inflammatory biomarkers correlate with disease severity and adverse outcomes, prompting the evaluation of anti-inflammatory therapies in several cardiovascular settings. Colchicine has demonstrated potential in reducing cardiovascular events, though recent trial data have raised concerns regarding its overall benefit and optimal application after myocardial infarction. Alternative agents targeting inflammatory pathways-such as monoclonal antibodies against interleukins (e.g. canakinumab, tocilizumab, ziltivekimab)-have shown biological efficacy but are not yet approved for routine clinical use in CVD. Emerging strategies, including immune-modulatory therapies and RNA-based interventions, seek to achieve selective anti-inflammatory effects with reduced immunosuppressive risk. Future approaches will likely adopt personalized, multi-targeted regimens that integrate inflammation control with lipid-lowering and antithrombotic therapies. As evidence accumulates, inflammation may transition from an adjunctive target to a central focus in CVD management.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Albumin level and risk of major bleeding in patients with atrial fibrillation on direct oral anticoagulants.","authors":"Shun Sasaki, Daisuke Sakamoto, Yuki Matsuoka, Katsuki Okada, Akihiro Sunaga, Daisaku Nakatani, Hidetaka Kioka, Takashi Kanda, Hitoshi Minamiguchi, Ryuta Watanabe, Kouichi Nagashima, Yoshiharu Higuchi, Yasuo Okumura, Yohei Sotomi, Yasushi Sakata","doi":"10.1093/ehjcvp/pvaf030","DOIUrl":"10.1093/ehjcvp/pvaf030","url":null,"abstract":"<p><strong>Aims: </strong>The pharmacological effect of direct oral anticoagulants (DOACs) is influenced by binding status with albumin. This study aimed to assess the association between albumin levels and bleeding risk in atrial fibrillation (AF) patients treated with DOACs.</p><p><strong>Methods and results: </strong>We conducted DIRECT-Extend registry (N = 7512), a pooled database combining three large-scale observational study of AF patients treated with DOAC. The primary endpoint was major bleeding as defined by International Society on Thrombosis and Haemostasis criteria. Multivariable Cox hazard model was used to assess the impact of albumin level on major bleeding. Out of the overall cohort, 2523 patients [73 (IQR 66-80) years, 1620 (64.2%) males] with albumin data available at enrolment were analyzed in this study. Median follow-up duration was 532 days (IQR 94-1405 days). The entire cohort was divided into tertiles based on albumin levels (lower tertile: <3.7 g/dL, middle tertile: 3.7-4.1 g/dL, and higher tertile: ≥4.1 g/dL). The incidences of major bleeding increased as albumin levels decreased; 56 patients (6.8%), 81 patients (9.7%), and 113 patients (13.1%) in the higher, middle, and lower tertiles, respectively. (Log-rank test P < 0.0001). A lower albumin level was independently associated with a higher incidence of major bleeding (adjusted hazard ratio 0.61, 95% confidence interval 0.47-0.80, P < 0.01), which was consistently observed in all DOACs (P-value for interaction >0.05).</p><p><strong>Conclusion: </strong>A lower albumin level was independently associated with a higher bleeding risk in AF patients using DOACs. Careful attention should be paid to hypoalbuminemia when prescribing DOACs.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"422-432"},"PeriodicalIF":6.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of pharmacological therapies in reducing outflow tract obstruction in patients with obstructive hypertrophic cardiomyopathy: a systematic review and meta-analysis.","authors":"Kamal Awad, Milagros Pereyra Pietri, Juan M Farina, Girish Pathangey, Mohammed Tiseer Abbas, Isabel G Scalia, David Le Couteur, Susan Wilanksy, Steven J Lester, Steve R Ommen, Jeffrey B Geske, Reza Arsanjani, Chadi Ayoub","doi":"10.1093/ehjcvp/pvaf036","DOIUrl":"10.1093/ehjcvp/pvaf036","url":null,"abstract":"<p><strong>Aims: </strong>Significant advancements have been made in the management of obstructive hypertrophic cardiomyopathy (oHCM), yet the extent of left ventricular outflow tract (LVOT) gradient reduction achieved with commonly used pharmacological therapies [beta-blockers (BBs), calcium channel blockers (CCBs), disopyramide, and cardiac myosin inhibitors (CMIs)] relative to each other is still unclear.</p><p><strong>Methods and results: </strong>PubMed and Scopus were searched up to September 2024. Clinical trials or observational studies that assessed the changes associated with BBs, CCBs, disopyramide, or CMIs in LVOT gradient at rest or with provocation in patients with oHCM were included. Mean changes in LVOT gradients were pooled as mean differences (MD) with 95% confidence intervals (CIs) in a random-effects model. Thirty-seven studies, with 44 arms and 1898 patients, were included in the analysis. At the therapeutic class level, pooled analysis showed that disopyramide was associated with the highest reduction in LVOT gradient at rest [MD: -43.5 (95% CI, -51.6 to -35.3)], followed by CMIs [MD: -34.8 (95% CI, -40.6 to -29.0)], BBs [MD: -20.7 (95% CI, -29.4 to -12.0)], and then CCBs [MD: -14.7 (95% CI, -23.3 to -6.1)], inter-action P < 0.01. Within CMIs, mavacamten had a higher effect than aficamten on gradient reduction; among the included BBs, metoprolol showed the highest gradient reduction, while among CCBs, verapamil was the most effective (inter-action P < 0.01). Similar results were observed for provocable LVOT gradients.</p><p><strong>Conclusion: </strong>Pharmacological therapies effectively reduced LVOT gradients in oHCM patients to varying degrees, with disopyramide and CMIs showing the highest effect, followed by BBs and CCBs.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"469-482"},"PeriodicalIF":6.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Our knowledge about atrial fibrillation steadily increases.","authors":"Stefan Agewall","doi":"10.1093/ehjcvp/pvaf050","DOIUrl":"10.1093/ehjcvp/pvaf050","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":"11 5","pages":"397-398"},"PeriodicalIF":6.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}