Echo Research and Practice最新文献

{"title":"Reproducibility of semi-quantitative assessment of aortic valve calcification and valve motion on echocardiography: a small-scale study.","authors":"D Balian, B Koethe, S Mohanty, Y Daaboul, S H Mahrokhian, J Frankel, J Li, A Kherlopian, B C Downey, B Wessler","doi":"10.1186/s44156-024-00050-3","DOIUrl":"10.1186/s44156-024-00050-3","url":null,"abstract":"<p><strong>Background: </strong>Aortic stenosis (AS) is the most common degenerative valve disease in high income countries. While hemodynamic metrics are commonly used to assess severity of stenosis, they are impacted by loading conditions and stroke volume and are often discordant. Anatomic valve assessments such as aortic valve calcification (AVC) and valve motion (VM) during transthoracic echocardiography (TTE) can offer clues to disease severity. The reliability of these semi-quantitatively assessed anatomic imaging parameters is unknown.</p><p><strong>Methods: </strong>This is a retrospective study of semi-quantitative assessment of AVC and valve VM on TTE. TTEs representing a range of AS severities were identified. The degree of calcification of the aortic valve and the degree of restricted VM were assessed in standard fashion. AVC scores and valve motion were assessed by readers with varied training levels blinded to the severity of AS. Correlation and inter-reader reliability between readers were assessed.</p><p><strong>Results: </strong>420 assessments (210 each for AVC and VM) were collected for 35 TTEs. Correlation of AVC for imaging trainees (fellows and students, respectively), ranged from 0.49 (95% CI 0.18-0.70) to 0.62 (95% CI 0.36-0.79) and 0.58 (95% CI 0.30-0.76) to 0.54 (95% CI 0.25-0.74) for VM. Correlation of anatomic assessments between echocardiographer-assigned AVC grades was r = 0.76 (95% CI 0.57-0.87)). The correlation between echocardiographer-assigned assessment of VM was r = 0.73 (95% CI 0.53-0.86), p < 0.00001 for both. For echocardiographer AVC assessment, weighted kappa was 0.52 (0.32-0.72), valve motion weighted kappa was 0.60 (0.42-0.78).</p><p><strong>Conclusion: </strong>There was good inter-reader correlation between TTE-based semi-quantitative assessment of AVC and VM when assessed by board certified echocardiographers. There was modest inter-reader reliability of semi-quantitative assessments of AVC and VM between board certified echocardiographers. Inter-reader correlation and reliability between imaging trainees was lower. More reliable methods to assess TTE based anatomic assessments are needed in order to accurately track disease progression.</p><p><strong>Clinical trial number: </strong>STUDY00003100.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11215824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471484","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":"Evaluation of left ventricular filling pressure by echocardiography in patients with atrial fibrillation.","authors":"Faraz H Khan, Debbie Zhao, Jong-Won Ha, Sherif F Nagueh, Jens-Uwe Voigt, Allan L Klein, Einar Gude, Kaspar Broch, Nicholas Chan, Gina M Quill, Robert N Doughty, Alistair Young, Ji-Won Seo, Eusebio García-Izquierdo, Vanessa Moñivas-Palomero, Susana Mingo-Santos, Tom Kai Ming Wang, Stephanie Bezy, Nobuyuki Ohte, Helge Skulstad, Carmen C Beladan, Bogdan A Popescu, Shohei Kikuchi, Vasileios Panis, Erwan Donal, Espen W Remme, Martyn P Nash, Otto A Smiseth","doi":"10.1186/s44156-024-00048-x","DOIUrl":"10.1186/s44156-024-00048-x","url":null,"abstract":"<p><strong>Background: </strong>Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation. The objective of the present study was to determine if a combination of several echocardiographic and clinical parameters may be used to evaluate LV filling pressure in patients with atrial fibrillation.</p><p><strong>Results: </strong>In a multicentre study of 148 atrial fibrillation patients, several echocardiographic parameters were tested against invasively measured LV filling pressure as the reference method. No single parameter had sufficiently strong association with LV filling pressure to be recommended for clinical use. Based on univariate regression analysis in the present study, and evidence from existing literature, we developed a two-step algorithm for differentiation between normal and elevated LV filling pressure, defining values ≥ 15 mmHg as elevated. The parameters in the first step included the ratio between mitral early flow velocity and septal mitral annular velocity (septal E/e'), mitral E velocity, deceleration time of E, and peak tricuspid regurgitation velocity. Patients who could not be classified in the first step were tested in a second step by applying supplementary parameters, which included left atrial reservoir strain, pulmonary venous systolic/diastolic velocity ratio, and body mass index. This two-step algorithm classified patients as having either normal or elevated LV filling pressure with 75% accuracy and with 85% feasibility. Accuracy in EF ≥ 50% and EF < 50% was similar (75% and 76%).</p><p><strong>Conclusions: </strong>In patients with atrial fibrillation, no single echocardiographic parameter was sufficiently reliable to be used clinically to identify elevated LV filling pressure. An algorithm that combined several echocardiographic parameters and body mass index, however, was able to classify patients as having normal or elevated LV filling pressure with moderate accuracy and high feasibility.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11145766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200780","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":"The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography.","authors":"Shaun Robinson, Liam Ring, David Oxborough, Allan Harkness, Sadie Bennett, Bushra Rana, Nilesh Sutaria, Francesco Lo Giudice, Matthew Shun-Shin, Maria Paton, Rae Duncan, James Willis, Claire Colebourn, Gemma Bassindale, Kate Gatenby, Mark Belham, Graham Cole, Daniel Augustine, Otto A Smiseth","doi":"10.1186/s44156-024-00051-2","DOIUrl":"10.1186/s44156-024-00051-2","url":null,"abstract":"<p><p>Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a stru","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11145885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200810","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":"Left and right ventricular strain-volume/area loops: a narrative review of current physiological understanding and potential clinical value.","authors":"Thijs P Kerstens, Stijn Cm Donker, Geert Kleinnibbelink, Arie Pj van Dijk, David Oxborough, Dick H J Thijssen","doi":"10.1186/s44156-024-00046-z","DOIUrl":"10.1186/s44156-024-00046-z","url":null,"abstract":"<p><p>Traditionally, echocardiography is used for volumetric measurements to aid in assessment of cardiac function. Multiple echocardiographic-based assessment techniques have been developed, such as Doppler ultrasound and deformation imaging (e.g., peak global longitudinal strain (GLS)), which have shown to be clinically relevant. Volumetric changes across the cardiac cycle can be related to deformation, resulting in the Ventricular Strain-Volume/Area Loop. These Loops allow assessment of the dynamic relationship between longitudinal strain change and volumetric change across both systole and diastole. This integrated approach to both systolic and diastolic function assessment may offer additional information in conjunction with traditional, static, measures of cardiac function or structure. The aim of this review is to summarize our current understanding of the Ventricular Strain-Volume/Area Loop, describe how acute and chronic exposure to hemodynamic stimuli alter Loop characteristics, and, finally, to outline the potential clinical value of these Loops in patients with cardiovascular disease. In summary, several studies observed Loop changes in different hemodynamic loading conditions and various (patho)physiological conditions. The diagnostic and prognostic value, and physiological interpretation remain largely unclear and have been addressed only to a limited extent.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072246","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":"Clinical scientist led healthcare in inherited cardiac conditions: a new frontier?","authors":"Stephen P Page, Gemma Bassindale","doi":"10.1186/s44156-024-00049-w","DOIUrl":"10.1186/s44156-024-00049-w","url":null,"abstract":"","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11075182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877625","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":"Heart valve service provision in the United Kingdom and the effect of the COVID 19 pandemic; improved but must do better. A British Heart Valve Society national survey.","authors":"R Mohindra, L E Dobson, D Schlosshan, P Khan, B Campbell, M Garbi, B Chambers, J B Chambers","doi":"10.1186/s44156-024-00047-y","DOIUrl":"10.1186/s44156-024-00047-y","url":null,"abstract":"<p><strong>Background: </strong>Outpatient care for patients with heart valve disease (HVD) is best provided by valve clinics delivered by specialists. Modern day practice in the United Kingdom (UK) is currently poorly understood and has not been evaluated for nearly a decade. Furthermore, the COVID 19 pandemic changed the management of many chronic diseases, and how this has impacted patients with heart valve disease is unclear.</p><p><strong>Methods: </strong>A British Heart Valve Society survey was sent to 161 hospitals throughout the UK.</p><p><strong>Results: </strong>There was a general valve clinic in 46 of the 68 hospitals (68%), in 19 of 23 Heart Centres (83%) and 29 of 45 DGHs (64%). Across all settings, 3824 new patients and 17,980 follow up patients were seen in valve clinics per annum. The mean number of patients per hospital were 197 (median 150, range 48-550) for new patients and 532 (median 400, range 150-2000) for follow up. On the day echocardiography was available in 55% of valve clinics. In patients with severe HVD, serum brain natriuretic peptide (BNP) was measured routinely in 39% of clinics and exercise testing routinely performed in 49% of clinics. A patient helpline was available in 27% of clinics. 78% of centres with a valve clinic had a valve multidisciplinary team meeting (MDT). 45% centres had an MDT co-ordinator and MDT outcomes were recorded on a database in 64%. COVID-19 had a major impact on valve services in 54 (95%) hospitals.</p><p><strong>Conclusions: </strong>There has been an increase in the number of valve clinics since 2015 from 21 to 68% but the penetration is still well short of the expected 100%, meaning that valve clinics only serve a small proportion of patients requiring surveillance for HVD. COVID-19 had a major impact on the care of patients with HVD in the majority of UK centres surveyed.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877626","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":"Implementing a clinical scientist-led screening clinic for hypertrophic and dilated cardiomyopathies","authors":"Jane Draper, Rachel Bastiaenen, Gerry Carr-White, Teofila Bueser, Jessica Webb, C. Evans, Soraya Nuthoo, Nabeel Sheikh","doi":"10.1186/s44156-024-00045-0","DOIUrl":"https://doi.org/10.1186/s44156-024-00045-0","url":null,"abstract":"","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role and application of three-dimensional transthoracic echocardiography in the assessment of left and right ventricular volumes and ejection fraction: a UK nationwide survey","authors":"Liam Corbett, Patrick O'Driscoll, Maria Paton, David Oxborough, Elena Surkova","doi":"10.1186/s44156-024-00044-1","DOIUrl":"https://doi.org/10.1186/s44156-024-00044-1","url":null,"abstract":"","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140750587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of machine learning models for estimation of left ventricular ejection fraction on point-of-care ultrasound: insights on features that impact performance.","authors":"Christina L Luong, Mohammad H Jafari, Delaram Behnami, Yaksh R Shah, Lynn Straatman, Nathan Van Woudenberg, Leah Christoff, Nancy Gwadry, Nathaniel M Hawkins, Eric C Sayre, Darwin Yeung, Michael Tsang, Ken Gin, John Jue, Parvathy Nair, Purang Abolmaesumi, Teresa Tsang","doi":"10.1186/s44156-024-00043-2","DOIUrl":"10.1186/s44156-024-00043-2","url":null,"abstract":"<p><strong>Background: </strong>Machine learning (ML) algorithms can accurately estimate left ventricular ejection fraction (LVEF) from echocardiography, but their performance on cardiac point-of-care ultrasound (POCUS) is not well understood.</p><p><strong>Objectives: </strong>We evaluate the performance of an ML model for estimation of LVEF on cardiac POCUS compared with Level III echocardiographers' interpretation and formal echo reported LVEF.</p><p><strong>Methods: </strong>Clinicians at a tertiary care heart failure clinic prospectively scanned 138 participants using hand-carried devices. Video data were analyzed offline by an ML model for LVEF. We compared the ML model's performance with Level III echocardiographers' interpretation and echo reported LVEF.</p><p><strong>Results: </strong>There were 138 participants scanned, yielding 1257 videos. The ML model generated LVEF predictions on 341 videos. We observed a good intraclass correlation (ICC) between the ML model's predictions and the reference standards (ICC = 0.77-0.84). When comparing LVEF estimates for randomized single POCUS videos, the ICC between the ML model and Level III echocardiographers' estimates was 0.772, and it was 0.778 for videos where quantitative LVEF was feasible. When the Level III echocardiographer reviewed all POCUS videos for a participant, the ICC improved to 0.794 and 0.843 when only accounting for studies that could be segmented. The ML model's LVEF estimates also correlated well with LVEF derived from formal echocardiogram reports (ICC = 0.798).</p><p><strong>Conclusion: </strong>Our results suggest that clinician-driven cardiac POCUS produces ML model LVEF estimates that correlate well with expert interpretation and echo reported LVEF.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10976698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307296","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":"Prevalence, characteristics and clinical impact of work-related musculoskeletal pain in echocardiography.","authors":"Eunice Onwordi, Alistair Harris, Charlotte Atkinson, Cathy West, Keith Pearce, Jane Hancock, Camelia Demetrescu, Dhrubo Rakhit, Benoy N Shah, Rajdeep Khattar, Jennifer Gorman, Delfin Encarnacion, Guy Lloyd, Sanjeev Bhattacharyya","doi":"10.1186/s44156-024-00042-3","DOIUrl":"10.1186/s44156-024-00042-3","url":null,"abstract":"<p><strong>Background: </strong>Work-related musculoskeletal pain (WRMSP) is increasingly recognised in cardiac ultrasound practice. WRMSP can impact workforce health, productivity and sustainability. We sought to investigate the prevalence, characteristics and clinical impact of WRMSP.</p><p><strong>Methods: </strong>Prospective electronic survey of 157 echocardiographers in 10 institutions. Data acquired on demographics, experience, working environment/pattern, WRMSP location, severity and pattern, the impact on professional, personal life and career.</p><p><strong>Results: </strong>129/157 (82%) echocardiographers completed the survey, of whom 109 (85%) reported WRMSP and 55 (43%) reported work taking longer due to WRMSP. 40/129 (31%) required time off work. 78/109 (60%) reported sleep disturbance with 26/78 (33%) of moderate or severe severity. 56/129 (45%) required medical evaluation of their WRMSP and 25/129 (19%) received a formal diagnosis of musculoskeletal injury. Those with 11+ years of experience were significantly more likely to receive a formal diagnosis of WRMSP (p = 0.002) and require medication (p = 0.006) compared to those with 10 years or less experience.</p><p><strong>Conclusion: </strong>WRMSP is very common amongst echocardiographers, with a fifth having a related musculoskeletal injury. WRMSP has considerable on impact on personal, social and work-related activities. Strategies to reduce the burden of WRMSP are urgently required to ensure sustainability of the workforce and patient access to imaging.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10916016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040606","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}