Bart J. J. Velders, Michiel D. Vriesendorp, Neil J. Weissman, Joseph F. Sabik III, Michael J. Reardon, Francois Dagenais, Michael G. Moront, Vivek Rao, Shinichi Fukuhara, Ralf Günzinger, Wouter J. van Leeuwen, W. Morris Brown, Rolf H. H. Groenwold, Robert J. M. Klautz, Federico M. Asch
{"title":"Core Laboratory Versus Center-Reported Echocardiographic Assessment of the Native and Bioprosthetic Aortic Valve","authors":"Bart J. J. Velders, Michiel D. Vriesendorp, Neil J. Weissman, Joseph F. Sabik III, Michael J. Reardon, Francois Dagenais, Michael G. Moront, Vivek Rao, Shinichi Fukuhara, Ralf Günzinger, Wouter J. van Leeuwen, W. Morris Brown, Rolf H. H. Groenwold, Robert J. M. Klautz, Federico M. Asch","doi":"10.1111/echo.70047","DOIUrl":"https://doi.org/10.1111/echo.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Insights into quantitative differences between core laboratory and center-reported echocardiographic assessment of the native and bioprosthetic aortic valve are lacking. We aimed to explore clinically relevant differences between these evaluations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial for the Avalus valve. In this trial, patients with an indication for surgical aortic valve replacement (SAVR) due to aortic stenosis or regurgitation (AR) were enrolled. Serial echocardiographic examinations were performed at each center and blindly reanalyzed by an independent echocardiographic core laboratory (ECL). For the bioprosthetic valve analysis, postoperative data throughout the 5-year follow-up were pooled. Differences between the ECL and the centers in continuous parameters were quantified in mean differences and intraclass correlation coefficients (ICCs). Agreement on AR, paravalvular leak (PVL), and prosthesis-patient mismatch (PPM) classification was investigated using Cohen's kappa coefficients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis on the native aortic valve was performed on 1118 echocardiograms. The relative mean difference was largest for the left ventricular outflow tract (LVOT) area, followed by stroke volume and effective orifice area (index), with center-reported values being 11%–7% higher. High ICCs of around 0.90 were observed for the parameters peak aortic jet velocity, mean pressure gradient, and the velocity-time integral across the aortic valve. Over 5000 echocardiograms were available for the bioprosthetic valve analysis. Therein, comparable results were observed. The kappa coefficient was 0.59 (95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28 (95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is high agreement between the ECL and clinical centers on continuous-wave Doppler-related measurements. In contrast, agreement is low for parameters that involve measurement of the LVOT diameter. These results provide important context for the interpretation of aortic valve performance in studies that lack central ECL evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT02088554</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesca Coraducci, Alessandro Barbarossa, Carla Lofiego, Fabio Vagnarelli, Nicolo Schicchi, Marco Fogante, Tommaso Piva, Filippo Capestro, Michela Casella, Marco Di Eusanio, Federico Guerra, Antonio Dello Russo
{"title":"Multimodality Imaging for Transcatheter Tricuspid Regurgitation Interventions: Novel Approaches to the Forgotten Valve","authors":"Francesca Coraducci, Alessandro Barbarossa, Carla Lofiego, Fabio Vagnarelli, Nicolo Schicchi, Marco Fogante, Tommaso Piva, Filippo Capestro, Michela Casella, Marco Di Eusanio, Federico Guerra, Antonio Dello Russo","doi":"10.1111/echo.70044","DOIUrl":"https://doi.org/10.1111/echo.70044","url":null,"abstract":"<p>Tricuspid regurgitation (TR) poses a significant healthcare burden and is a major concern for patients who experience debilitating symptoms and face a poorer prognosis. Cardiologists are showing renewed interest in TR, as the previous belief that it was merely a bystander of left-sided heart disease has evolved. As a result, more transcatheter techniques addressing TR are emerging. Although a clear impact on mortality from these transcatheter tricuspid valve interventions (TTVI) has not yet been demonstrated, the improvement in symptoms and quality of life for patients is substantial, leading to increased use of these procedures in clinical practice. In this review, we focus on multimodality imaging as an essential tool for quantifying TR severity, assessing right ventricular (RV) function, understanding the underlying mechanisms, selecting the appropriate intervention, and ensuring thorough and accurate preprocedural planning to minimize complications.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ginevra Fioretti, Alice Tolomei, Piera Ciaramella, Antonio Lio, Ernesto Cristiano, Giulio Cacioli, Federica Tempestini, Federico Ranocchi, Viviana Maestrini, Amedeo Pergolini
{"title":"Study of Degenerative Mitral Regurgitation Using Three-Dimensional Echocardiography and EchoPAC GE Health Care Software 4D Auto MVQ: Comparison Between Transthoracic and Transesophageal Examination","authors":"Ginevra Fioretti, Alice Tolomei, Piera Ciaramella, Antonio Lio, Ernesto Cristiano, Giulio Cacioli, Federica Tempestini, Federico Ranocchi, Viviana Maestrini, Amedeo Pergolini","doi":"10.1111/echo.70040","DOIUrl":"10.1111/echo.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preoperative echocardiographic assessment is critical for patients with severe degenerative mitral regurgitation to ensure personalized surgical mitral valve repair. This study aimed to compare the diagnostic accuracy of three-dimensional transthoracic echocardiography (3D TTE) and three-dimensional transesophageal echocardiography (3D TEE) in identifying valvular lesions, using surgical findings as the reference. Additionally, we evaluated whether annular dimensional parameters derived from TTE and TEE, using dedicated 3D software, could confirm whether 3D TTE alone offers a comprehensive preoperative evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 60 patients with severe organic mitral regurgitation scheduled for surgical valve repair. Each patient underwent preoperative 3D TTE, intraoperative 3D TEE prior to surgery, followed by annuloplasty. Mitral valve reconstructions from both TTE and TEE were compared, and dedicated 3D software (EchoPAC GE-Health-Care Software 3D-auto-MVQ) was employed to reconstruct annular geometries from both methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both 3D TTE and 3D TEE demonstrated comparable accuracy in identifying diseased scallops (overall accuracy: 3D TTE 91.8%, 3D TEE 98.1%, <i>p</i> > 0.05). However, 3D TTE was inferior to 3D TEE in identifying multiple chordal ruptures (accuracy: 3D TTE 80%, 3D TEE 100%). Quantitative analysis of the mitral annulus revealed that 3D TTE and 3D TEE yielded overlapping results for static parameters (<i>p</i> > 0.05), whereas dynamic parameters differed significantly (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the selected population, 3D TTE demonstrated diagnostic accuracy comparable to transesophageal echocardiography in identifying mitral valve lesions. Furthermore, with the use of dedicated 3D software, TTE alone may provide a comprehensive and noninvasive preoperative evaluation, particularly for static annular parameters. Further studies are warranted to corroborate these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Karamarkou, Charalampia Maltsinioti, Oliver Bruder, Mehran Babady
{"title":"Multimodality Imaging in Chronic Constrictive Pericarditis","authors":"Christina Karamarkou, Charalampia Maltsinioti, Oliver Bruder, Mehran Babady","doi":"10.1111/echo.70037","DOIUrl":"10.1111/echo.70037","url":null,"abstract":"<div>\u0000 \u0000 <p>This case highlights the use of multimodality imaging in the diagnosis and management of chronic constrictive pericarditis (CP) in a 37-year-old male with a history of T-wave inversions on electrocardiogram (ECG). The patient underwent adenosine stress cardiac magnetic resonance (CMR) due to suspicion of coronary artery disease (CAD). CMR revealed findings suggestive of chronic CP, including pericardial thickening and septal shudder, with computed tomography (CT) confirming the presence of pericardial calcification. The diagnosis was established through the combination of CMR and CT imaging. The patient underwent a successful pericardiectomy. This case emphasizes the crucial role of CMR and CT in diagnosing and guiding the management of CP.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pietro Costantini, Léon Groenhoff, Eleonora Ostillio, Francesca Coraducci, Francesco Secchi, Alessandro Carriero, Anna Colarieti, Alessandro Stecco
{"title":"Advancements in Cardiac CT Imaging: The Era of Artificial Intelligence","authors":"Pietro Costantini, Léon Groenhoff, Eleonora Ostillio, Francesca Coraducci, Francesco Secchi, Alessandro Carriero, Anna Colarieti, Alessandro Stecco","doi":"10.1111/echo.70042","DOIUrl":"https://doi.org/10.1111/echo.70042","url":null,"abstract":"<p>In the last decade, artificial intelligence (AI) has influenced the field of cardiac computed tomography (CT), with its scope further enhanced by advanced methodologies such as machine learning (ML) and deep learning (DL). The AI-driven techniques leverage large datasets to develop and train algorithms capable of making precise evaluations and predictions. The realm of cardiac CT is expanding day by day and multiple tools are offered to answer different questions. Coronary artery calcium score (CACS) and CT angiography (CTA) provide high-resolution images that facilitate the detailed anatomical evaluation of coronary plaque burden. New tools such as myocardial CT perfusion (CTP) and fractional flow reserve (FFR<sub>CT</sub>) have been developed to add a functional evaluation of the stenosis. Moreover, epicardial adipose tissue (EAT) is gaining interest as its role in coronary artery plaque development has been deepened. Seen the great added value of these tools, the demand for new exams has increased such as the burden on imagers. Due to its ability to fast compute multiple data, AI can be helpful in both the acquisition and post-processing phases. AI can possibly reduce radiation dose, increase image quality, and shorten image analysis time. Moreover, different types of data can be used for risk assessment and patient risk stratification. Recently, the focus of the scientific community on AI has led to numerous studies, especially on CACS and CTA. This narrative review concentrates on AI's role in the post-processing of CACS, CTA, FFR<sub>CT</sub>, CTP, and EAT, discussing both current capabilities and future directions in the field of cardiac imaging.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karla A. Pupiales-Davila, Maryuri M. D. Chumbes-Aguirre, Alexis Y. Fernandez-Rivera, Pablo Hernandez-Reyes, Xochitl A. Ortiz-Leon
{"title":"Incidental Finding of a Myxoma of Unusual Location in an Elderly Patient","authors":"Karla A. Pupiales-Davila, Maryuri M. D. Chumbes-Aguirre, Alexis Y. Fernandez-Rivera, Pablo Hernandez-Reyes, Xochitl A. Ortiz-Leon","doi":"10.1111/echo.70036","DOIUrl":"10.1111/echo.70036","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Milzi, Antonio Landi, Rosalia Dettori, Kathrin Burgmaier, Sebastian Reith, Mathias Burgmaier
{"title":"Multimodal Intravascular Imaging of the Vulnerable Coronary Plaque","authors":"Andrea Milzi, Antonio Landi, Rosalia Dettori, Kathrin Burgmaier, Sebastian Reith, Mathias Burgmaier","doi":"10.1111/echo.70035","DOIUrl":"10.1111/echo.70035","url":null,"abstract":"<div>\u0000 \u0000 <p>Vulnerable coronary plaques are atherosclerotic lesions which, due to their specific phenotype, are prone to plaque rupture and to cause acute coronary syndromes, with subsequent relevant morbidity and mortality. Strategies to break the chain link between plaque vulnerability and adverse clinical events include optimized pharmacologic prevention and potentially also preemptive percutaneous coronary interventions (previously defined as “plaque sealing” or “plaque passivation”). Various morphologic features of the vulnerable plaques have been described, including aspects regarding the large necrotic lipid content, the thin fibrous cap, the presence and extent of the presence of calcifications with small size and calcification angle, and as well as the large macrophage infiltration within the plaque. The detection of these features of plaque vulnerability is possible with intravascular imaging modalities such as intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS), and optical coherence tomography (OCT). This review explores the peculiarities of these three imaging modalities for the detection of vulnerable coronary plaque features.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Veronika Zach, Philipp Lacour, Lina Alasfar, Alexandra Maria Chitroceanu, Cristina Rozados da Conceicao, Daniel Armando Morris, Henryk Dreger, Florian Blaschke, Matthias Schneider-Reigbert
{"title":"A Novel 2D Echo View to Determine Right Ventricular Lead Position on the Tricuspid Valve Level","authors":"Veronika Zach, Philipp Lacour, Lina Alasfar, Alexandra Maria Chitroceanu, Cristina Rozados da Conceicao, Daniel Armando Morris, Henryk Dreger, Florian Blaschke, Matthias Schneider-Reigbert","doi":"10.1111/echo.70033","DOIUrl":"10.1111/echo.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Recently, a subcostal en-face view of the tricuspid valve (TV) was described which can determine right ventricular (RV) lead position on the TV level. We sought to (1) prospectively evaluate the feasibility of this novel view in patients with cardiac implantable electronic devices (CIED) to visualize the position of the device lead relative to the TV leaflets and (2) study the association between lead position and degree of tricuspid regurgitation (TR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with a history of CIED implantation with at least one RV lead who underwent echocardiography for any cause at our tertiary center were included in this prospective observational study. A subcostal 2D en-face view of the TV was obtained and the position of the RV lead in the TV plane was determined whenever feasible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 176 patients were included, 70% were male, the median age was 74 years. The exact RV lead position in respect to the TV plane could be determined in 112/176 patients (64%) via the proposed view. In 37 patients (21%) moderate TR could be found, while 10 patients (6%) presented with severe TR. The lead position was not associated with the degree of TR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A novel 2D en-face view of the TV can accurately identify the RV lead position in the TV plane. At least moderate TR was present in 27% of patients with CIED. There was no association of lead position with the occurrence of moderate or more TR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Candido, Amedeo Pergolini, Daniele Pontillo, Marco Russo, Antonio Giovanni Cammardella, Giordano Zampi, Carla Manzara, Mauro Pennacchi, Federico Ranocchi
{"title":"Takotsubo Cardiomyopathy Following MitraClip Procedure: Focus On","authors":"Francesco Candido, Amedeo Pergolini, Daniele Pontillo, Marco Russo, Antonio Giovanni Cammardella, Giordano Zampi, Carla Manzara, Mauro Pennacchi, Federico Ranocchi","doi":"10.1111/echo.70027","DOIUrl":"10.1111/echo.70027","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Overlapping Strain Patterns in Patients With Cardiac Amyloidosis and End-Stage Renal Disease","authors":"Janez Toplišek, Marta Cvijić","doi":"10.1111/echo.70039","DOIUrl":"10.1111/echo.70039","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}