Journal of the American College of Cardiology最新文献

{"title":"Revealing the Hidden Layers: Focus on Social and Psychological Determinants in Congenital Heart Surgery Prognosis","authors":"Zhangxin Wen, Sihan Duan, Hong Liu","doi":"10.1016/j.jacc.2024.07.060","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.07.060","url":null,"abstract":"No Abstract","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665360","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":"Glycemic Control and Coronary Stent Failure in Patients With Type 2 Diabetes Mellitus","authors":"Chao Liu, Ximing Li, Hongliang Cong","doi":"10.1016/j.jacc.2024.07.062","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.07.062","url":null,"abstract":"No Abstract","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"18 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665364","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":"Oxidized Phospholipids and Calcific Aortic Valvular Disease","authors":"Harpreet S. Bhatia, Marc R. Dweck, Neil Craig, Romain Capoulade, Philippe Pibarot, Patrick J. Trainor, Seamus P. Whelton, Rishi Rikhi, Karita C.F. Lidani, Wendy S. Post, Michael Y. Tsai, Michael H. Criqui, Michael D. Shapiro, Matthew J. Budoff, Andrew P. DeFilippis, George Thanassoulis, Sotirios Tsimikas","doi":"10.1016/j.jacc.2024.08.070","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.08.070","url":null,"abstract":"<h3>Background</h3>Oxidized phospholipids (OxPLs) are carried by apolipoprotein B-100–containing lipoproteins (OxPL-apoB) including lipoprotein(a) (Lp[a]). Both OxPL-apoB and Lp(a) have been associated with calcific aortic valve disease (CAVD).<h3>Objectives</h3>This study aimed to evaluate the associations between OxPL-apoB, Lp(a) and the prevalence, incidence, and progression of CAVD.<h3>Methods</h3>OxPL-apoB and Lp(a) were evaluated in MESA (Multi-Ethnic Study of Atherosclerosis) and a participant-level meta-analysis of 4 randomized trials of participants with established aortic stenosis (AS). In MESA, the association of OxPL-apoB and Lp(a) with aortic valve calcium (AVC) at baseline and 9.5 years was evaluated using multivariable ordinal regression models. In the meta-analysis, the association between OxPL-apoB and Lp(a) with AS progression (annualized change in peak aortic valve jet velocity) was evaluated using multivariable linear regression models.<h3>Results</h3>In MESA, both OxPL-apoB and Lp(a) were associated with prevalent AVC (OR per SD: 1.19 [95% CI: 1.07-1.32] and 1.13 [95% CI: 1.01-1.27], respectively) with a significant interaction between the two (<em>P</em> &lt; 0.01). Both OxPL-apoB and Lp(a) were associated with incident AVC at 9.5 years when evaluated individually (interaction <em>P</em> &lt; 0.01). The OxPL-apoB∗Lp(a) interaction demonstrated higher odds of prevalent and incident AVC for OxPL-apoB with increasing Lp(a) levels. In the meta-analysis, when analyzed separately, both OxPL-apoB and Lp(a) were associated with faster increase in peak aortic valve jet velocity, but when evaluated together, only OxPL-apoB remained significant (ß: 0.07; 95% CI: 0.01-0.12).<h3>Conclusions</h3>OxPL-apoB is a predictor of the presence, incidence, and progression of AVC and established AS, particularly in the setting of elevated Lp(a) levels, and may represent a novel therapeutic target for CAVD.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"7 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637622","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":"Treating Older Patients in Cardiogenic Shock with a Microaxial Flow Pump: Is it DANGERous?","authors":"Anika Klein, Rasmus P. Beske, Christian Hassager, Lisette O. Jensen, Hans Eiskjær, Norman Mangner, Axel Linke, Amin Polzin, P. Christian Schulze, Carsten Skurk, Peter Nordbeck, Peter Clemmensen, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Nikos Werner, Thomas Engstøm, Lene Holmvang, Anders Junker, Henrik Schmidt, Jacob E. Møller","doi":"10.1016/j.jacc.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.003","url":null,"abstract":"<h3>Background</h3>Whether age impacts the recently demonstrated survival benefit of microaxial flow pump (mAFP) treatment in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) is unknown.<h3>Objectives</h3>The purpose of this study was to assess the impact of age on mortality and complication rates in patients with STEMI-related CS randomized to standard care or mAFP on top of standard care.<h3>Methods</h3>This is a secondary analysis of the Danish-German Cardiogenic Shock (DanGer Shock) trial, an international, multicenter, open-label trial, in which 355 adult patients with STEMI-related CS were randomized to receive a mAFP (Impella CP) plus standard care or standard care alone. The primary outcome of 180-day all-cause mortality is analysed according to age and intervention.<h3>Results</h3>From lowest to highest age quartile, the median ages (range) were: 54 (31-59), 65 (60-69), 73 (70-76), and 81 (77-92) years. There were no differences in blood pressure, lactate level, left ventricular ejection fraction or shock severity at randomization across age groups.Mortality increased from lowest to highest quartile (31%, 47%, 61%, and 73%, respectively; log-rank p&lt;0.001), with an adjusted odds ratio (OR) for death at 180 days of 7.85 (95% CI, 3.37-19.2; p&lt;0.001) in the highest quartile compared to the lowest. The predicted risk of mortality was higher in the standard-care group until approximately 77 years, after which the predicted risk became higher in the mAFP group (p-interaction=0.2). In patients younger than 77 years, a reduced 180-day mortality was observed in patients randomized to the mAFP (OR, 0.45; 95% CI, 0.28-0.73; p=0.001), opposed to patients aged 77 years or older (OR, 1.52; 95% CI, 0.57–4.08; p=0.40), p=0.028 for interaction. Complications were more frequent in the mAFP group, but there were no apparent differences in incidence of complications across all ages.<h3>Conclusions</h3>This exploratory secondary analysis of the DanGer Shock trial demonstrates that elderly patients with STEMI-related CS experience high mortality and may not attain the same benefit from routine treatment with a mAFP as younger patients. Incorporating age as a factor in patient selection may enhance the overall benefit of this therapy. (DanGer Shock, NCT01633502)","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"19 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637583","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":"Systolic Blood Pressure and Pulse Pressure in Heart Failure: Pooled Participant-Level Analysis of Four Trials","authors":"Henri Lu, Toru Kondo, Brian L. Claggett, Muthiah Vaduganathan, Brendon L. Neuen, Iris E. Beldhuis, Pardeep S. Jhund, Finnian R. Mc Causland, Inder S. Anand, Marc A. Pfeffer, Bertram Pitt, Faiez Zannad, Michael R. Zile, John J.V. McMurray, Scott D. Solomon, Akshay S. Desai","doi":"10.1016/j.jacc.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.007","url":null,"abstract":"<h3>Background</h3>Hypertension is common in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), and current guidelines recommend treating systolic blood pressure (SBP) to a target below 130 mmHg. However, data supporting treatment to this target is limited. Additionally, pulse pressure (PP), a marker of aortic stiffness, has been associated with increased risk of cardiovascular events, but its prognostic impact in HFpEF has not been extensively studied.<h3>Objectives</h3>This study aimed to explore the impact of baseline SBP and PP on cardiovascular outcomes in patients with HFmrEF or HFpEF.<h3>Methods</h3>I-PRESERVE, TOPCAT-Americas, PARAGON-HF and DELIVER were global, randomized clinical trials testing irbesartan, spironolactone, sacubitril/valsartan and dapagliflozin respectively, against either a placebo or an active comparator (valsartan, in PARAGON-HF), in patients with HF and a left ventricular ejection fraction ≥40% (in DELIVER) or ≥45% (in the other trials). The relationship between continuous baseline SBP and PP, and the primary endpoint (first HF hospitalization or cardiovascular death) was analyzed with restricted cubic splines. We further evaluated the prognostic impact of SBP categories (&lt;120, 120-129, 130-139, ≥140 mmHg) and PP quartiles on the primary endpoint.<h3>Results</h3>A total of 16,950 patients (mean age 71±9 years, 49% male, mean SBP 131±15 mmHg, mean PP 55±14 mmHg) were included. The relationship between SBP and the primary endpoint was J-shaped, with the lowest risk at 120-130 mmHg. A similar pattern was found for PP, with the lowest risk at 50-60 mmHg. The highest SBP category (reference: 120-129 mmHg) and PP quartile (reference: 46-54 mmHg) were associated with a higher risk of the primary outcome (HR: 1.22; 95% CI: 1.10-1.34; HR: 1.22; 95% CI: 1.11-1.34, respectively). Higher PP was associated with greater cardiovascular risk, regardless of SBP.<h3>Conclusions</h3>Our analysis of a large pooled dataset from four clinical trials, including over 16,900 patients with HFmrEF/HFpEF, indicates a J-shaped relationship between both SBP and PP, and cardiovascular risk. The lowest risk was observed at SBP levels between 120 and 130 mmHg and PP values between 50 and 60 mmHg.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637574","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":"Intensive lifestyle intervention, cardiac biomarkers, and cardiovascular outcomes in diabetes: LookAHEAD cardiac biomarker ancillary study","authors":"Kershaw V. Patel, Zainali Chunawala, Subodh Verma, Matthew W. Segar, Katelyn R. Garcia, Chiadi E. Ndumele, Thomas J. Wang, James L. Januzzi, Antoni Bayes-Genis, Javed Butler, Carolyn S.P. Lam, Christie M. Ballantyne, James A. de Lemos, Alain G. Bertoni, Mark Espeland, Ambarish Pandey","doi":"10.1016/j.jacc.2024.11.004","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.004","url":null,"abstract":"<h3>Background</h3>NT-proBNP and hs-cTnT are associated with cardiovascular outcomes and are recommended for measurement in type 2 diabetes (T2D). However, the effects of an intensive lifestyle intervention (ILI) targeting weight loss on cardiac biomarkers and the prognostic association of changes in these biomarkers with risk of adverse cardiovascular outcomes in T2D are not well-established.<h3>Objectives</h3>To evaluate the effects of an ILI on cardiac biomarkers and the association of changes in cardiac biomarkers with risk of cardiovascular outcomes in T2D.<h3>Methods</h3>Participants of the LookAHEAD trial underwent NT-proBNP and hs-cTnT measurement at baseline (N=3,984), 1- and 4-years. The effects of the ILI (vs. diabetes support and education [DSE]) on cardiac biomarkers were assessed using adjusted linear mixed-effect models and summarized as geometric mean ratios (GMR). Associations of longitudinal changes in cardiac biomarkers with risk of cardiovascular outcomes were assessed using adjusted Cox models.<h3>Results</h3>Average baseline NT-proBNP and hs-cTnT was 77 and 10.7 ng/L, respectively. The ILI (vs. DSE) led to an increase in NT-proBNP at 1-year (GMR[95% CI]: 1.14[1.08-1.20]), but this difference was attenuated by 4-years (GMR[95% CI]: 1.01[0.96-1.07]). The ILI (vs. DSE) led to lower hs-cTnT at 1-year (GMR[95% CI]: 0.94[0.91-0.97]) and 4-years (GMR[95% CI]: 0.93 [0.90-0.96]). Participants with meaningful weight loss by 1-year (≥5% vs. &lt;5%) had a significant increase in NT-proBNP in the short-term (year-1) which attenuated in the long-term follow-up (year-4). Meaningful 1-year weight loss was significantly associated with reduction in hs-cTnT in the long-term. In adjusted Cox-models, increase in NT-proBNP was significantly associated with higher risk of the composite ASCVD outcome and HF independent of baseline measure of the cardiac biomarker and changes in risk factors. In contrast, longitudinal increase in hs-cTnT was significantly associated with higher risk of the composite ASCVD outcome but not HF in the most adjusted model.<h3>Conclusions</h3>Among adults with T2D, an ILI led to a significant reduction in hs-cTnT on follow-up but a transient increase in NT-proBNP levels at 1-year that attenuated over time. Longitudinal assessment of NT-proBNP and hs-cTnT provide prognostic information for ASCVD risk while only changes in NT-proBNP predicted HF risk.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"9 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637580","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":"Calcific Aortic Valve Disease: Lp(a) Takes the Heat, But Is OxPL Really Fanning the Flames?","authors":"Maxim E. Annink, S. Matthijs Boekholdt, Erik S.G. Stroes","doi":"10.1016/j.jacc.2024.09.1240","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.09.1240","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Funding Support and Author Disclosures</h2>Dr Stroes has received lecturing/Advisory Board fees from Amgen, Sanofi, Novo Nordisk, Novartis, Ionis, and AstraZeneca. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.</section></section>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"35 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637579","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":"P2Y12 Inhibitor Pretreatment in Non–ST-Segment Elevation Acute Coronary Syndrome: The NCDR Chest Pain-MI Registry","authors":"Hiroki A. Ueyama, Kevin F. Kennedy, Jennifer A. Rymer, Alexander T. Sandhu, Toshiki Kuno, Frederick A. Masoudi, John A. Spertus, Shun Kohsaka","doi":"10.1016/j.jacc.2024.09.1227","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.09.1227","url":null,"abstract":"<h3>Background</h3>Although high rates of P2Y₁₂ inhibitor pretreatment (defined as the administration before coronary angiography) for non–ST-segment elevation acute coronary syndrome (NSTE-ACS) have been reported, contemporary U.S. practice patterns are not well studied.<h3>Objectives</h3>The goal of this study was to investigate the temporal U.S. trends, variability, and clinical outcomes of P2Y₁₂ inhibitor pretreatment in NSTE-ACS.<h3>Methods</h3>Consecutive patients who underwent early invasive strategy for NSTE-ACS (coronary angiography ≤24 hours of arrival) in the National Cardiovascular Data Registry Chest Pain-Myocardial Infarction (MI) Registry were analyzed. A time-trend analysis was conducted on a complete cohort between January 1, 2013, and March 31, 2023. Subsequently, a more recent cohort (January 1, 2019, to March 31, 2023) with a complete set of variables was used to construct hierarchical regression models to quantify the variability in the use of pretreatment among operators and institutions. For this contemporary cohort, instrumental variable analysis, with operator preference as the instrument, was performed to compare the in-hospital outcomes between patients who received pretreatment and those who did not.<h3>Results</h3>Use of P2Y₁₂ inhibitor pretreatment decreased from 24.8% in 2013Q1 to 12.4% in 2023Q1. Among the contemporary cohort of 110,148 patients (2019-2023; mean age 63.9 ± 12.5 years; 33.0% female), 17,509 (15.9%) received pretreatment. Significant variability in P2Y₁₂ inhibitor pretreatment was observed (range: 0%-100%): hierarchical regression model demonstrated that 2 similar patients would have a &gt;3-fold difference in the odds of pretreatment from 1 random operator or institution as compared with another (median OR: 3.74 [95% CI: 3.57-3.91] and 3.63 [95% CI: 3.51-3.74], respectively). Instrumental variable analysis demonstrated no significant differences in in-hospital all-cause death (1.5% vs 1.7%; <em>P</em> = 0.07), recurrent MI (0.6% vs 0.6%; <em>P</em> = 0.98), or major bleeding (2.7% vs 2.8%; <em>P</em> = 0.98) with pretreatment. However, in patients who underwent coronary artery bypass surgery, pretreatment was associated with a longer length of stay (11.2 ± 5.1 days vs 9.8 ± 5.0 days; <em>P</em> &lt; 0.01).<h3>Conclusions</h3>In a national U.S. registry, we observed significant variability in the use of P2Y₁₂ inhibitor pretreatment among NSTE-ACS patients. Given the lack of clear advantages and the potential for prolonged hospital stays, our findings highlight the importance of efforts to improve standardization.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"9 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637578","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":"What Is the Rush?: Optimizing the Timing of P2Y12 Inhibition in Non–ST-Segment Elevation Acute Coronary Syndromes","authors":"Joseph M. Kim, Robert W. Yeh, Eric A. Secemsky","doi":"10.1016/j.jacc.2024.10.099","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.10.099","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Funding Support and Author Disclosures</h2>Dr Kim has received research funding from the National Institutes of Health (T32HL160522). Dr Yeh has received research funding from Boston Scientific, Abbott, and Medtronic; and has served as a consultant for Boston Scientific, Abbott, Medtronic, Edwards Lifesciences, CathWorks, and Shockwave. Dr Secemsky has received research funding from the National Institutes of Health National Heart, Lung, and Blood Institute (K23HL150290), the U.S. Food and Drug Administration, SCAI, Abbott/CSI, Becton</section></section>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"35 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637624","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":"Understanding The Impact of Vertical Integration on Cardiovascular Care Quality: A Complex and Worthwhile Endeavor","authors":"Daniel M. Blumenthal, John Hsu","doi":"10.1016/j.jacc.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.013","url":null,"abstract":"No Abstract","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637577","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}