Heart最新文献

{"title":"Heart murmurs in the general population: diagnostic value and prevalence from the Tromsø Study.","authors":"Anne Herefoss Davidsen, Stian Andersen, Peder Andreas Halvorsen, Juan Carlos Aviles Solis, Henrik Schirmer, Hasse Melbye","doi":"10.1136/heartjnl-2024-325499","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325499","url":null,"abstract":"<p><strong>Background: </strong>Heart auscultation is a widely used and cost-effective clinical tool for detecting valvular heart disease (VHD), particularly in primary care. However, existing evidence on its diagnostic accuracy is limited by small sample sizes, specialist-led studies and high-prevalence settings. Robust population-based data are lacking. This study aimed to assess the prevalence and diagnostic accuracy of heart murmurs for identifying VHD in a general adult population, using echocardiography as the reference standard.</p><p><strong>Methods: </strong>We conducted a diagnostic accuracy study within the Seventh Tromsø Study (2015-2016), involving 2082 participants aged ≥40 years (mean age 63 years). Heart sounds were recorded at four chest locations and independently classified by general practitioners (GPs) blinded to echocardiographic results. Murmurs were graded and categorised as systolic or diastolic. Clinically significant VHD was defined as ≥mild aortic stenosis (AS) or ≥moderate aortic regurgitation (AR) or mitral regurgitation (MR). We calculated sensitivity, specificity, predictive values and likelihood ratios for murmur detection.</p><p><strong>Results: </strong>GPs detected heart murmurs in 487 participants (23%). Significant VHD was identified in 392 participants (19%), but only 139 of them (35.5%) had an audible murmur. Systolic murmurs detected all cases of AS (sensitivity 100%, specificity 78%). Sensitivity was lower for AR (43%) and MR (29%), while specificity of distinct murmurs exceeded 94% across all VHD types. Diastolic murmurs were rare (n=9) but highly specific (>99%). Among participants with murmurs, age ≥70 years (OR 2.0, 95% CI 1.2 to 3.4), male sex (OR 3.3, 95% CI 2.0 to 5.3) and previous myocardial infarction (OR 2.3, 95% CI 1.0 to 5.2) were independently associated with VHD.</p><p><strong>Conclusion: </strong>In this general adult population, heart auscultation by GPs identified murmurs in nearly one in four individuals and showed high specificity but limited sensitivity for diagnosing VHD. Auscultation remains a valuable initial screening tool-especially for AS-but should be complemented by echocardiography in older or high-risk individuals.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of renal function on platelet aggregation: a comparative study of prasugrel and clopidogrel.","authors":"Ayane Miyagi, Toshiki Maeda, Hisatomi Arima, Kaoru Akimaru, Hiroki Uehara, Namio Higa, Masanori Kakazu, Minoru Wake, Taketoshi Maeda, Haruno Nagata, Shinya Shiohira, Yuichiro Toma, Hidekazu Ikemiyagi, Masashi Iwabuchi, Kenya Kusunose","doi":"10.1136/heartjnl-2024-325399","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325399","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease is common in patients with coronary artery disease (CAD) and can significantly affect drug excretion and efficacy. This study focuses on the effects of modification of renal function on platelet aggregation.</p><p><strong>Methods: </strong>In total, 164 patients with stable CAD undergoing dual antiplatelet therapy were enrolled and randomised to receive either 75 mg clopidogrel or 3.75 mg prasugrel daily. Patients were stratified based on estimated glomerular filtration rate (eGFR) into two groups: eGFR <45 (eGFR <45 group) or ≥45 mL/min/1.73 m² (eGFR ≥45 group). The primary endpoint was the inhibition of platelet aggregation on day 5 and day 30. Analysis of covariance was performed to compare the P2Y₁₂ reaction units (PRU) on days 5 and 30 after randomisation.</p><p><strong>Results: </strong>In the eGFR <45 group, prasugrel induced a more rapid decrease in platelet aggregation than clopidogrel. Mean PRU value for clopidogrel and prasugrel at baseline, day 5 and day 30 was 198.2 vs 177.2, 214.2 vs 157.9 and 200.0 vs 141.7, respectively. The differences were statistically significant on day 5 (p=0.036), but not on day 30 (p=0.105). The p for interaction between treatment effect and eGFR was 0.498 at baseline, 0.028 at day 5 and 0.212 at day 30, emphasising that the drug effect was significantly different by kidney function, but only in the early phase of drug initiation.</p><p><strong>Conclusion: </strong>In patients with impaired renal function, prasugrel provided a more rapid reduction in platelet aggregation compared with clopidogrel, particularly during the early phase of antiplatelet treatment. Further research is needed to confirm these findings in larger and more diverse populations.</p><p><strong>Trial registration number: </strong>URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000027055; Unique identifier: UMIN000023489.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subphenogroups of acute heart failure with preserved ejection fraction: comprehensive proteomics and pathway analysis.","authors":"Yohei Sotomi, Yuki Matsuoka, Christina Ebert, Zhaoqing Wang, Tomohito Ohtani, Karl Kammerhoff, Laura Liu, Peter Schafer, Ching-Pin Chang, David Gordon, Shungo Hikoso, Julio A Chirinos, Lei Zhao, Yasushi Sakata","doi":"10.1136/heartjnl-2025-326091","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326091","url":null,"abstract":"<p><strong>Background: </strong>Heterogeneity of heart failure with preserved ejection fraction (HFpEF) results in significant challenges for treatment development. Identifying and characterising distinct HFpEF phenogroups may aid in tailoring therapeutic strategies for these patients. The objective of this study was to assess proteomic patterns of HFpEF phenogroups identified through a machine-learning-based clustering model, with the aim of uncovering specific biological pathways associated with each phenogroup.</p><p><strong>Methods: </strong>This study represents a post-hoc analysis of the ongoing Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a multicentre prospective observational study of hospitalised patients with acute decompensated HFpEF. Of the overall cohort (N=1238), this study analysed 198 patients with HFpEF with available proteomics data. These patients were classified into four phenogroups using the machine-learning-based clustering model. The SomaScan assay V.4.1 was used to measure levels of >7000 plasma proteins, and subsequent pathway analysis was conducted to determine the biological differences among the phenogroups.</p><p><strong>Results: </strong>We identified four distinct phenogroups: Phenogroup 1 ('rhythm trouble'), Phenogroup 2 ('ventricular-arterial uncoupling'), Phenogroup 3 ('low output and systemic congestion') and Phenogroup 4 ('systemic failure'). The proteomics revealed distinct protein expression profiles among the phenogroups, with ribonuclease 4, tax1-binding protein 1, regenerating islet-derived protein 3-gamma and alpha-1-antichymotrypsin being the most significant markers to specific identified phenogroups. Pathway analysis suggested differences in immune response, autonomic activation, cellular homeostasis and tissue repair mechanisms across the phenogroups.</p><p><strong>Conclusions: </strong>Using a comprehensive plasma proteomics approach, our study identified distinct proteomic profiles of HFpEF phenogroups, which in turn suggest specific underlying biological processes. These profiles suggest the involvement of inflammatory activation, tissue injury and regenerative responses, immune modulation and systemic stress signalling as key components of HFpEF pathophysiology.</p><p><strong>Trial registration number: </strong>UMIN-CTR ID: UMIN000021831.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of coronary stents: innovations, antithrombotic strategies and future directions.","authors":"William A E Parker","doi":"10.1136/heartjnl-2024-324744","DOIUrl":"10.1136/heartjnl-2024-324744","url":null,"abstract":"<p><p>Implantation of drug-eluting stents (DESs) remains central to percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) and chronic coronary syndromes (CCS). DES platforms, polymers and drugs have evolved significantly to improve deliverability and safety, now being typically thin-strut with a compact layer of biocompatible or bioresorbable polymer, or no polymer at all. Ultra-thin-strut DESs push this concept further, and in some studies perform better than conventional DES, but may recoil in challenging settings such as chronic total occlusion PCI. Stent implantation has also progressed, with greater attention to lesion preparation and poststenting optimisation, increased use of intracoronary imaging helping to recognise and remedy issues. In parallel, antithrombotic therapy for patients undergoing PCI has advanced considerably, with reliable P2Y₁₂ inhibition now possible with the newest agents. As well as progress in controlling other thrombotic risk factors such as hyperlipidaemia, hypertension and diabetes, these developments have contributed to reducing thrombotic risk. As well as preventing stent thrombosis, antithrombotic therapy can reduce the risk of non-PCI-related thrombotic events, not only in the coronary tree but also in the cerebral and peripheral circulation, however it increases bleeding risk. Twelve months of dual antiplatelet therapy (DAPT) after PCI for ACS (and 6 months after PCI for CCS) remains the default recommended strategy, but given reliable P2Y₁₂ inhibition, good control of ischaemic risk factors and a minimally thrombogenic stent design and deployment, it is rational that earlier de-escalation to monotherapy, particularly with ticagrelor, is often appropriate, reserving longer-duration DAPT for those with highest ischaemic risk but where bleeding risk is not high. A body of trial evidence now supports this. As well as earlier de-escalation of DAPT, future developments in PCI might include increased use of 'leave nothing behind' strategies and further pharmacological options for optimisation of ischaemic risk factors.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"753-762"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed opportunities to manage complex comorbidity of heart failure, type 2 diabetes mellitus and chronic kidney disease: a retrospective cohort study.","authors":"Laura Pasea, Mohamed Mohamed, Ashkan Dashtban, Anish Bhuva, Mehrdad A Mizani, Sarah Ali, Thomas Oates, Mamas A Mamas, Tamsin Morris, He Gao, Jil Billy Mamza, Amitava Banerjee","doi":"10.1136/heartjnl-2024-325046","DOIUrl":"10.1136/heartjnl-2024-325046","url":null,"abstract":"<p><strong>Background: </strong>Effective management of coexisting heart failure (HF), chronic kidney disease (CKD) and type 2 diabetes mellitus (T2D) is critical, yet evidence of adherence to guideline-recommended standards in routine care remains unclear. We aimed to assess primary care adherence to guideline-recommended standards for patients with overlapping HF, CKD and T2D in England.</p><p><strong>Methods: </strong>Using UK Clinical Practice Research Datalink (1998-2020), we evaluated care adherence across 161 529 individuals with HF, CKD or T2D before and after developing a second of these conditions. We analysed disease investigation rates, medication use and predictors of guideline adherence.</p><p><strong>Results: </strong>We identified 161 529 patients with CKD followed by HF (CKD+HF, 40%), CKD+T2D (51.3%) and HF+T2D (8.6%) with a median of 3.1 years follow-up after the second diagnosis. In CKD+HF, CKD+T2D and HF+T2D groups, prescription rates of renin-angiotensin system inhibitors (71%, 64.1% and 74.4%), beta-blockers (53.1%,36.2% and 55.1%), antiplatelets (56.2%, 45.2% and 54.4%) and statins (56.7%, 68.5% and 72%) were suboptimal. Advanced age, female sex, peripheral arterial disease and cancer were associated with a lower likelihood of checking blood pressure, creatinine and glycated haemoglobin (HbA1C) after HF, CKD and T2D diagnoses, respectively. The first diagnosis of HF was associated with reduced odds of having HbA1C measured after T2D diagnosis (OR 0.79, 95% CI 0.72 to 0.86), compared with CKD as the first diagnosis.</p><p><strong>Conclusions: </strong>In overlapping HF, CKD and T2D, guideline-recommended care is suboptimal, with inequalities by age, sex, disease on first presentation and comorbidities. Quality improvement requires linked data collection, monitoring and action across diseases.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"776-785"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of self-reported and accelerometer-based walking pace with incident cardiac arrhythmias: a prospective cohort study using UK Biobank.","authors":"Pei Qin, Frederick K Ho, Carlos A Celis-Morales, Stewart G Trost, Jill P Pell","doi":"10.1136/heartjnl-2024-325004","DOIUrl":"10.1136/heartjnl-2024-325004","url":null,"abstract":"<p><strong>Objectives: </strong>Dedicated studies aimed at investigating the relationship between walking pace and arrhythmia are limited. This study assessed associations between self-reported and accelerometer measured walking pace and incident cardiac arrhythmias, overall and by subtype, and explored metabolic and inflammatory markers as possible mediators.</p><p><strong>Methods: </strong>Self-reported average walking pace was available for 420 925 UK Biobank participants, and accelerometer measured time spent walking at different paces was available for 81 956 participants. Outcomes were incident cardiac arrhythmias: all, atrial fibrillation (AF), other (including bradyarrhythmias and ventricular arrhythmias), bradyarrhythmias and ventricular arrhythmias. Cox proportional regression models were used to investigate the associations.</p><p><strong>Results: </strong>Compared with slow walking pace, average and brisk walking pace were associated with significantly lower risks of all cardiac arrhythmias (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.62 to 0.68; HR 0.57, 95% CI 0.54 to 0.60), AF (HR 0.62, 95% CI 0.58 to 0.65; HR 0.54, 95% CI 0.50 to 0.57) and other arrhythmias (HR 0.69, 95% CI 0.64 to 0.73; HR 0.61, 95% CI 0.57 to 0.65). Overall, 36.0% of the association between walking pace and all arrhythmias was mediated via metabolic and inflammatory markers. The associations were stronger in women, in those aged <60 years, in those with a body mass index <30, in those who had hypertension and in those with ≥2 long term conditions.</p><p><strong>Conclusions: </strong>Average and brisk self-reported walking pace and time spent walking at moderate and brisk pace were associated with a decreased risk of cardiac arrhythmias, in part mediated via metabolic and inflammatory pathways. Our findings suggest brisk walking may be a safe and effective exercise to reduce arrhythmias, especially for higher risk groups.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"763-768"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifactorial management of complex comorbidity followed by heart failure, chronic kidney disease and type 2 diabetes mellitus: the way to overcome missed opportunities.","authors":"Alexander Berezin","doi":"10.1136/heartjnl-2025-325804","DOIUrl":"10.1136/heartjnl-2025-325804","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"747-748"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TAVI for asymptomatic aortic stenosis? More compelling outcome data are needed.","authors":"Gerry P McCann, David E Newby, Graham S Hillis","doi":"10.1136/heartjnl-2025-325767","DOIUrl":"10.1136/heartjnl-2025-325767","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"749-752"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term benefits of atorvastatin on the incidence of cardiovascular events: the ASCOT-Legacy 20-year follow-up.","authors":"Peter S Sever, Somayeh Rostamian, William Whiteley, Cono Ariti, Thomas Godec, Ajay Gupta, Judith Mackay, Andrew Whitehouse, Neil R Poulter","doi":"10.1136/heartjnl-2024-325104","DOIUrl":"10.1136/heartjnl-2024-325104","url":null,"abstract":"<p><strong>Aims: </strong>Cardiovascular (CV) deaths were reduced by atorvastatin during a 16-year follow-up of participants in the Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm. We now extend these observations over 20 years and report both non-fatal and fatal CV outcomes.</p><p><strong>Methods: </strong>A cohort of 4605 UK hypertensive participants with total cholesterol <6.5 mmol/L (2317 atorvastatin vs 2288 placebo) was followed for up to 21 years (IQR 9.1-19.3). Cox proportional hazard models assessed HRs for non-fatal and fatal CV events. At the end of the original trial (3.3 years), all participants were offered atorvastatin. Lipid profiles were obtained from all subjects 2 years later and from subgroups approximately 9 years post-trial.</p><p><strong>Results: </strong>Patients allocated to atorvastatin had a significant reduction in non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD) events (HR (95% CI) 0.81 (0.69 to 0.94, p=0.006)), total coronary events (0.88 (0.80 to 0.98, p=0.017)) and CV deaths (0.86 (0.74 to 0.99, p=0.048)). No significant reduction in heart failure (HF), strokes, total CV events and all-cause mortality was observed.In participants assigned atorvastatin in the trial, 3-year mean low-density lipoprotein-cholesterol was strongly associated with long-term CV outcomes. The HRs per 1 mmol/L decrease were for non-fatal MI and fatal CHD (0.69 (0.57 to 0.85, p<0.001)), total coronary events (0.70 (0.61 to 0.79, p<0.001)), non-fatal and fatal HF (0.68 (0.57 to 0.81, p<0.001)), non-fatal and fatal stroke (0.74 (0.59 to 0.92, p=0.006)), total CV events and procedures (0.74 (0.66 to 0.81, p<0.001)), CV mortality (0.66 (0.55 to 0.81, p<0.001)) and all-cause mortality (0.81 (0.71 to 0.90, p<0.001)).Two years after the trial, approximately two-thirds of subjects in each arm were taking atorvastatin. At this time point and approximately 9 years post-trial, lipid profiles were similar between those formerly assigned atorvastatin or placebo.</p><p><strong>Conclusions: </strong>These observations provide further evidence for the long-term legacy effects of statins and have implications for the early introduction of statins to prevent CV events and mortality.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"769-775"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legacy effects in extension studies: standing the test of time.","authors":"Natalia Fabin, Xavier Rossello","doi":"10.1136/heartjnl-2025-325897","DOIUrl":"10.1136/heartjnl-2025-325897","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"745-746"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}