Structural HeartPub Date : 2024-05-01DOI: 10.1016/j.shj.2024.100284
Avalon Moonen BSc (Med), MBBS , Jacob Cao BSc, MSc, MClinTRes, MBBS , David S. Celermajer MBBS, MSc, PhD, DSc , Martin K.C. Ng BSc (Med), MBBS, PhD
{"title":"Mitral Regurgitation “Proportionality” in Functional Mitral Regurgitation and Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair: A Systematic Review and Meta-Analysis","authors":"Avalon Moonen BSc (Med), MBBS , Jacob Cao BSc, MSc, MClinTRes, MBBS , David S. Celermajer MBBS, MSc, PhD, DSc , Martin K.C. Ng BSc (Med), MBBS, PhD","doi":"10.1016/j.shj.2024.100284","DOIUrl":"10.1016/j.shj.2024.100284","url":null,"abstract":"<div><h3>Background</h3><p>Certain patients with functional mitral regurgitation survive longer with fewer heart failure hospitalizations after undergoing transcatheter edge-to-edge repair (TEER); however, clinical markers identifying who will benefit have not been established. The ‘proportionality’ of mitral regurgitation (MR) severity compared to left ventricular size has been hypothesized to predict clinical outcome.</p></div><div><h3>Methods</h3><p>We sought to combine existing studies to compare outcomes between ‘proportionate’ MR and ‘disproportionate’ MR in patients undergoing TEER. PubMed and Medline were searched from January 2018 until May 2023. Data was extracted and synthesized by 2 independent authors using random effects models with risk ratios (RRs) for binary outcomes. The primary outcome was a combined endpoint of all-cause mortality or heart failure hospitalization (ACM/HFH). Other outcomes of interest included ACM and residual >2+ MR after TEER.</p></div><div><h3>Results</h3><p>Six trials with a total of 1594 patients (mean age 71 years, 66% male) were included, which assessed MR proportionality using either a ratio of estimated regurgitant orifice area to left ventricular end-diastolic volume (EROA:LVEDV) or regurgitant fraction. Seven hundred and five (mean age 70 years, 75% male) were classified as proportionate MR, and 889 (mean age 72 years, 60% male) had disproportionate MR. There was no significant association between MR proportionality (by EROA:LVEDV) and ACM (RR 0.79, 95% confidence interval [CI] 0.44-1.42). Proportionality did not significantly associate with ACM/HFH, though there were divergent effect signals when proportionality was measured by EROA:LVEDV (RR 0.80, 95% CI 0.45-1.44) or regurgitant fraction (RR 1.48, 95% CI 0.53-4.11). Disproportionate MR showed a greater association with residual MR > 2+ post-TEER that did not meet statistical significance (RR 1.86, 95% CI 0.77-4.49).</p></div><div><h3>Conclusions</h3><p>In patients undergoing TEER for functional mitral regurgitation, MR proportionality was not significantly associated with ACM/HFH, all-cause mortality, or residual MR.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 3","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870624000058/pdfft?md5=8212e46dbf1c702c282aaad71e901e22&pid=1-s2.0-S2474870624000058-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Structural HeartPub Date : 2024-05-01DOI: 10.1016/j.shj.2024.100282
Mark Lachmann MD , Amelie Hesse , Teresa Trenkwalder MD , Erion Xhepa MD, PhD , Tobias Rheude MD , Moritz von Scheidt MD , Héctor Alfonso Alvarez Covarrubias MD , Elena Rippen , Oksana Hramiak MD , Costanza Pellegrini MD , Tibor Schuster PhD , Shinsuke Yuasa MD, PhD , Heribert Schunkert MD , Adnan Kastrati MD , Christian Kupatt MD , Karl-Ludwig Laugwitz MD , Michael Joner MD
{"title":"Invasive Assessment of Right Ventricular to Pulmonary Artery Coupling Improves 1-year Mortality Prediction After Transcatheter Aortic Valve Replacement and Anticipates the Persistence of Extra-Aortic Valve Cardiac Damage","authors":"Mark Lachmann MD , Amelie Hesse , Teresa Trenkwalder MD , Erion Xhepa MD, PhD , Tobias Rheude MD , Moritz von Scheidt MD , Héctor Alfonso Alvarez Covarrubias MD , Elena Rippen , Oksana Hramiak MD , Costanza Pellegrini MD , Tibor Schuster PhD , Shinsuke Yuasa MD, PhD , Heribert Schunkert MD , Adnan Kastrati MD , Christian Kupatt MD , Karl-Ludwig Laugwitz MD , Michael Joner MD","doi":"10.1016/j.shj.2024.100282","DOIUrl":"10.1016/j.shj.2024.100282","url":null,"abstract":"<div><h3>Background</h3><p>The interplay between the right ventricle and the pulmonary artery, known as right ventricular to pulmonary artery (RV-PA) coupling, is crucial for assessing right ventricular systolic function against the afterload from the pulmonary circulation. Pulmonary artery pressure levels are ideally measured by right heart catheterization. Yet, echocardiography represents the most utilized method for evaluating pulmonary artery pressure levels, albeit with limitations in accuracy. This study therefore aims to evaluate the prognostic significance of right ventricular to pulmonary artery (RV-PA) coupling expressed as tricuspid annular plane systolic excursion (TAPSE) related to systolic pulmonary artery pressure (sPAP) levels measured by right heart catheterization (TAPSE/sPAP<sub>invasive</sub>) or estimated by transthoracic echocardiography (TAPSE/sPAP<sub>echocardiography</sub>) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).</p></div><div><h3>Methods</h3><p>Using data from a bicentric registry, this study compares TAPSE/sPAP<sub>invasive</sub> vs. TAPSE/sPAP<sub>echocardiography</sub> in predicting 1-year all-cause mortality after TAVR.</p></div><div><h3>Results</h3><p>Among 333 patients with complete echocardiography and right heart catheterization data obtained before TAVR, their mean age was 79.8 ± 6.74 years, 39.6% were female, and general 1-year survival was 89.8%. sPAP<sub>invasive</sub> and sPAP<sub>echocardiography</sub> showed only moderate correlation (Pearson correlation coefficient <em>R</em>: 0.53, <em>p</em> value: <0.0001). TAPSE/sPAP<sub>invasive</sub> was superior to TAPSE/sPAP<sub>echocardiography</sub> in predicting 1-year all-cause mortality after TAVR (area under the curve: 0.662 vs. 0.569, <em>p</em> value: 0.025). Patients with reduced TAPSE/sPAP<sub>invasive</sub> levels (< 0.365 mm/mmHg) evidenced significantly lower 1-year survival rates than patients with preserved TAPSE/sPAP<sub>invasive</sub> levels (81.8 vs. 93.6%, <em>p</em> value: 0.001; hazard ratio for 1-year mortality: 3.09 [95% confidence interval: 1.55-6.17]). Echocardiographic follow-up data revealed that patients with reduced RV-PA coupling suffer from persistent right ventricular dysfunction (TAPSE: 16.6 ± 4.05 mm vs. 21.6 ± 4.81 mm in patients with preserved RV-PA coupling) and severe tricuspid regurgitation (diagnosed in 19.7 vs. 6.58% in patients with preserved RV-PA coupling).</p></div><div><h3>Conclusions</h3><p>RV-PA coupling expressed as TAPSE/sPAP<sub>invasive</sub> can refine stratification of severe aortic stenosis patients into low-risk and high-risk cohorts for mortality after TAVR. Moreover, it can help to anticipate persistent extra-aortic valve cardiac damage, which will demand further treatment.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 3","pages":"Article 100282"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870624000034/pdfft?md5=5f97f85c49901f16d7ee37b81b333d78&pid=1-s2.0-S2474870624000034-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140270442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intentional Oversizing of Valve in Transcatheter Aortic Valve Replacement: Is Bigger Better? A Large, Single-Center Experience","authors":"Khawaja Afzal Ammar MD , Alexandria Graeber BS , Abdur Rahman Ahmad MD , Jodi Zilinski MD , Daniel P. O’Hair MD , Renuka Jain MD , Suhail Q. Allaqaband MD , Tanvir Bajwa MD","doi":"10.1016/j.shj.2023.100278","DOIUrl":"10.1016/j.shj.2023.100278","url":null,"abstract":"<div><h3>Background</h3><p>The current clinical practice standard is 10% to 20% oversizing of self-expanding valves in transcatheter aortic valve replacement. We aimed to determine whether >20% oversizing of self-expanding valves (Medtronic Evolut) would lead to better valve performance with similar or better outcomes.</p></div><div><h3>Methods</h3><p>From October 2011 to December 2016, we approached all transcatheter aortic valve replacement patients with a conscious attempt at large oversizing (>20%). The most common valve used, excluding those used in valve-in-valve patients, was the 29-mm Evolut R (29%). We used a retrospective chart review to compare moderate oversizing (group 1; 10% to 20%) with large oversizing (group 2; >20%).</p></div><div><h3>Results</h3><p>Of 556 patients, 45% were male; the overall mean Society of Thoracic Surgeons risk score was 5.8 ± 3.8. Eighty-five (15%) patients needed a pacemaker, and 21 (3.8%) developed significant paravalvular leak. Mean oversizing was 20.3% ± 6.0%, with 41.4% of patients included in group 1 and 54.5% in group 2. Incidences of complications in group 2 vs. group 1 were as follows: a) paravalvular leak (2.0 vs. 6.1%; odds ratio = 0.31, <em>p</em> = 0.01), b) pacemaker (15 vs. 14%), c) gastrointestinal bleed (n = 4 vs. 0; 1.3 vs. 0.0%; <em>p</em> = 0.03), d) annular dissection (n = 1 vs. 0; 0.3 vs. 0%; <em>p</em> = 0.29), e) mortality (n = 5 vs. 4; 1.6 vs. 1.7%). Incidence of paravalvular leak was higher in those who died than survivors (13 vs. 1.3%; <em>p</em> ≤ 0.0001).</p></div><div><h3>Conclusions</h3><p>These data suggest that, in current self-expanding valves, >20% oversizing delivers a significantly lower prevalence of paravalvular leak without an increase in other complications. Since paravalvular leak is associated with increased mortality, >20% oversizing may represent a superior prosthesis choice.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 3","pages":"Article 100278"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870623002294/pdfft?md5=618648d083cfd5a7c1c483c5ce1b3ec9&pid=1-s2.0-S2474870623002294-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139883518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Structural HeartPub Date : 2024-05-01DOI: 10.1016/j.shj.2023.100277
Akihiro Tobe MD , Scot Garg MD, PhD , Helge Möllmann MD, PhD , Andreas Rück MD, PhD , Won-Keun Kim MD , Andrea Buono MD , Andrea Scotti MD , Azeem Latib MD , Stefan Toggweiler MD , Antonio Mangieri MD , Mika Laine MD , Christopher U. Meduri MD , Tobias Rheude MD , Ivan Wong MBBS , Chenniganahosahalli Revaiah Pruthvi MD , Tsung-Ying Tsai MD , Yoshinobu Onuma MD, PhD , Patrick W. Serruys MD, PhD
{"title":"Short-Term Outcomes of ACURATE neo2","authors":"Akihiro Tobe MD , Scot Garg MD, PhD , Helge Möllmann MD, PhD , Andreas Rück MD, PhD , Won-Keun Kim MD , Andrea Buono MD , Andrea Scotti MD , Azeem Latib MD , Stefan Toggweiler MD , Antonio Mangieri MD , Mika Laine MD , Christopher U. Meduri MD , Tobias Rheude MD , Ivan Wong MBBS , Chenniganahosahalli Revaiah Pruthvi MD , Tsung-Ying Tsai MD , Yoshinobu Onuma MD, PhD , Patrick W. Serruys MD, PhD","doi":"10.1016/j.shj.2023.100277","DOIUrl":"10.1016/j.shj.2023.100277","url":null,"abstract":"<div><p>Inferior outcomes with ACURATE neo, a self-expanding transcatheter heart valve (THV) for the treatment of severe aortic stenosis, were mainly driven by higher rates of moderate/severe paravalvular leak (PVL). To overcome this limitation, the next-generation ACURATE neo2 features a 60% larger external sealing skirt. Data on long-term performance are limited; however, clinical evidence suggests improved short-term performance which is comparable to contemporary THVs. This report reviews data on short-term clinical and echocardiographic outcomes of ACURATE neo2. A PubMed search yielded 13 studies, including 5 single arm and 8 nonrandomized comparative studies with other THVs which reported in-hospital or 30-day clinical and echocardiographic outcomes. In-hospital or 30-day all-cause mortality was ≤3.3%, which is comparable to other contemporary THVs. The rates of postprocedural ≧moderate PVL ranged 0.6%-4.7%. In multicenter propensity-matched analyses, neo2 significantly reduced the rate of ≧moderate PVL compared to neo (3.5% vs. 11.3%, p < 0.01), whereas rates were comparable to Evolut Pro/Pro+ (Neo2: 2.0% vs. Pro/Pro+: 3.1%, p = 0.28) and SAPIEN 3 Ultra (Neo2: 0.6% vs. Ultra: 1.1%, p = 0.72). The rate of permanent pacemaker implantation with neo2 was consistently low (3.3%-8.6%) except in one study, and in propensity-matched analyses were significantly lower than Evolut Pro/Pro+ (6.7% vs. 16.7%, p < 0.01), and comparable to SAPIEN 3 Ultra (8.1% vs. 10.3%, p = 0.29). In conclusion, ACURATE neo2 showed better short-term performance by considerably reducing PVL compared to its predecessor, with short-term clinical and echocardiographic outcomes comparable to contemporary THVs.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 3","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870623002282/pdfft?md5=b52e350ca005dbd2fd259164fed64bbe&pid=1-s2.0-S2474870623002282-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139684005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Structural HeartPub Date : 2024-05-01DOI: 10.1016/j.shj.2024.100294
Philippe Généreux MD , Krzysztof Wróbel MD, PhD , Michael J. Rinaldi MD , Thomas Modine MD, PhD , Vinayak Bapat MD , Vlasis Ninios MD , Paul Sorajja MD
{"title":"AltaValve Atrial Fixation System for the Treatment of Severe Mitral Regurgitation and Mitral Annular Calcification","authors":"Philippe Généreux MD , Krzysztof Wróbel MD, PhD , Michael J. Rinaldi MD , Thomas Modine MD, PhD , Vinayak Bapat MD , Vlasis Ninios MD , Paul Sorajja MD","doi":"10.1016/j.shj.2024.100294","DOIUrl":"10.1016/j.shj.2024.100294","url":null,"abstract":"<div><h3>Background</h3><p>Treatment options for patients with mitral regurgitation (MR) and mitral annular calcification (MAC) are limited. The limitations of current transcatheter mitral valve replacement (TMVR) technologies include high screen failure rates, increased risk of left ventricular outflow tract obstruction, and high residual regurgitation. The aim of this study was to evaluate outcomes of TMVR with the AltaValve system (4C Medical, Maple Grove, MN), a supra-annular TMVR with atrial fixation, in patients with severe MR and moderate or severe MAC.</p></div><div><h3>Methods</h3><p>Six patients with moderate or severe MAC who were treated with AltaValve TMVR had procedural and mid-term outcomes available.</p></div><div><h3>Results</h3><p>Technical success was achieved in all patients. Median follow-up was 232 days. At discharge, 80% of patients had none/trace MR, and 20% had mild MR. There was no intraprocedural mortality, device malposition, embolization, or thrombosis. One patient expired 3 days postprocedure due to complications related to the transapical access. All other patients were discharged from the hospital without issues. Echocardiography assessments at 30 days showed complete resolution of MR in all patients, with 1 patient with mild MR and a mean mitral valve gradient of 3.7 ± 1.4 mmHg. All patients were in New York Heart Association Class I/II at 30-day follow-up, showing marked improvement as compared with baseline.</p></div><div><h3>Conclusions</h3><p>In patients with severe MR and severe MAC, the AltaValve TMVR technology may represent a viable treatment option. The atrial fixation minimizes the risk of left ventricular outflow tract obstruction and potentially expands treatable patients, especially in patients with MAC.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 3","pages":"Article 100294"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870624000253/pdfft?md5=a83d817d1ffc1b4a3a7e2f92204ac847&pid=1-s2.0-S2474870624000253-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Structural HeartPub Date : 2024-05-01DOI: 10.1016/j.shj.2023.100276
Go Hashimoto MD , Santiago Garcia MD , Hirotomo Sato MD, PhD , Miho Fukui MD, PhD , Muhammad Hammadah MD , Robert Steffen MD , Joao L. Cavalcante MD , Vinayak N. Bapat MD
{"title":"New Insights and Perspective on Bioprosthetic Valve Fracture From Bench Testing and Computed Tomography Analysis","authors":"Go Hashimoto MD , Santiago Garcia MD , Hirotomo Sato MD, PhD , Miho Fukui MD, PhD , Muhammad Hammadah MD , Robert Steffen MD , Joao L. Cavalcante MD , Vinayak N. Bapat MD","doi":"10.1016/j.shj.2023.100276","DOIUrl":"10.1016/j.shj.2023.100276","url":null,"abstract":"<div><h3>Background</h3><p>Bioprosthetic valve fracture (BVF) during valve-in-valve TAVR (transcatheter aortic valve replacement) is a procedural adjunct designed to optimize the expansion of the transcatheter heart valve and reduce patient-prosthesis mismatch by using a high-pressure balloon to intentionally fracture the surgical heart valve (SHV).</p></div><div><h3>Methods</h3><p>We performed bench testing on 15 bioprosthetic SHV to examine the optimal balloon size and pressure for BVF. We assessed morphological changes and expansion of SHV by computed tomography angiography. Successful BVF was defined as balloon waist disappearance on fluoroscopy and/or sudden pressure drop during balloon inflation.</p></div><div><h3>Results</h3><p>Nine valves met the definition of BVF, 3 of which were confirmed by disruption of the stent frame. We classified surgical valves into 3 subsets: 1) fracturable with metal stent frame (MSF), 2) fracturable with polymer stent frame (PSF) and 3) nonfracturable. In general, valves with MSF were fractured using a balloon size = true internal diameter plus 3-5 mm inflated at high pressure (16-20 ATM) whereas valves with PSF could be fractured with a balloon size = true internal diameter plus 3-5 mm and lower balloon pressure (6-14 ATM). Gains in computed tomography angiography derived inflow area after BVF were 12.3% for MSF and 3.6% for PSF SHV.</p></div><div><h3>Conclusions</h3><p>Gains in CT-determined valve area after BVF depend on the physical properties of the SHV, which in turn influences pressure thresholds and balloon sizing strategy for optimal BVF. Elastic recoil of PSF valves limits the gains in inflow area after BVF.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 3","pages":"Article 100276"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870623002270/pdfft?md5=dc4b4504d617eb1cce9871314a0e5ed4&pid=1-s2.0-S2474870623002270-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139827128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Structural HeartPub Date : 2024-05-01DOI: 10.1016/j.shj.2024.100281
Vilhelmas Bajoras MD , Ivan Wong MD , Xi Wang MD , Kamilė Čerlinskaitė-Bajorė MD , Gintautas Bieliauskas MD , Ole De Backer MD, PhD
{"title":"A Comparative Study of Transcatheter Aortic Valve Implantation Views for Two Different Self-Expanding Aortic Valves","authors":"Vilhelmas Bajoras MD , Ivan Wong MD , Xi Wang MD , Kamilė Čerlinskaitė-Bajorė MD , Gintautas Bieliauskas MD , Ole De Backer MD, PhD","doi":"10.1016/j.shj.2024.100281","DOIUrl":"10.1016/j.shj.2024.100281","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 3","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870624000022/pdfft?md5=16411e5d7dcdfc2ee893605fa4b529b4&pid=1-s2.0-S2474870624000022-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}