American Journal of Cardiology最新文献

{"title":"Systematic Review and Meta-analysis of Short-Term Outcomes in Patients Following Protected High-Risk PCI","authors":"Gianluca Di Pietro ,&nbsp;Riccardo Improta ,&nbsp;Ovidio De Filippo ,&nbsp;Francesco Bruno ,&nbsp;Lucia Ilaria Birtolo ,&nbsp;Riccardo Colantonio ,&nbsp;Achille Gaspardone ,&nbsp;Fabrizio Tomai ,&nbsp;Gennaro Sardella ,&nbsp;Fabrizio D’Ascenzo ,&nbsp;Massimo Mancone","doi":"10.1016/j.amjcard.2025.09.008","DOIUrl":"10.1016/j.amjcard.2025.09.008","url":null,"abstract":"<div><div>Surgical revascularization is still considered the gold standard for patients with complex coronary artery disease and left ventricular dysfunction. The advent of Impella has sparked growing interest, yet current evidence on its efficacy remains inconclusive. All studies reporting outcomes beyond 30 days outcomes of pPCI with any Impella device were included. Pooled effect of estimated outcomes was calculated according to a random-effect model with generic inverse variance weighting. Primary endpoint was all-cause mortality. Secondary outcomes were myocardial infarction, repeat revascularization, rehospitalization for heart failure and stroke. Six studies globally encompassing 1,581 patients were included in the quantitative analysis. Median age was 70 years old (IQR 69 to 72) with a median left ventricular ejection fraction (LVEF) of 27 % (SD ± 6) and a SYNTAX SCORE of 31 (IQR 29 to 35). Impella 2.5 was the most common micro axial flow pump used to support high-risk PCI. All-cause of death was observed in 13.4% (95% CI: 10.4 to 16.4) of patients at 6 months median follow-up. Myocardial infarction occurred in 5.8% (95% CI 3.4 to 8.1) of patients, repeat revascularization in 9.1% (95% CI: 4.8 to 13.3) of patients, stroke in 1.6% (IQR 1.2 to 2.1) of patients and, finally, heart failure rehospitalization in 8.4% (95% CI 3.3 to 13.6) of patients. In conclusion, for high-risk patients, PCI with the Impella device represented a viable strategy with an acceptable risk profile when surgical revascularization is not an option, and a poor prognosis is predicted.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 172-179"},"PeriodicalIF":2.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Network Meta-Analysis of Axillary, Femoral, and Central Arterial Cannulation In Minimally Invasive Cardiac Surgery.","authors":"Maria Comanici, Niloofar Khoshdel, Abu Ali Farmidi, Gurkan Ayaz, Anton Sabashnikov, Sunil Kishore Bhudia, Toufan Bahrami, Shahzad Gull Raja","doi":"10.1016/j.amjcard.2025.09.049","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.049","url":null,"abstract":"<p><p>The optimal arterial cannulation site in minimally invasive cardiac surgery (MICS) remains debated. While axillary, femoral, and central approaches each offer distinct advantages, no prior network meta-analysis has compared all three. We conducted a Bayesian network meta-analysis of 11 retrospective studies including 11,353 patients to evaluate their impact on postoperative outcomes. The analysis examined mortality, stroke, acute kidney injury (AKI), aortic dissection, atrial fibrillation, reoperation for bleeding, and length of stay, reporting odds ratios (ORs) with 95% credible intervals (CrIs) and ranking strategies using SUCRA probabilities. Central cannulation was associated with the lowest odds of stroke and aortic dissection, whereas axillary cannulation carried significantly higher odds of stroke compared with central (OR 4.66; 95% CrI 1.60-17.08) and ranked lowest across most outcomes. Femoral cannulation demonstrated favourable trends in in-hospital mortality (OR 0.61; 95% CrI 0.13-1.69 vs. central) and AKI (OR 0.65; 95% CrI 0.35-1.19), although not statistically significant. SUCRA rankings identified central as most favourable for neurologic and vascular complications, and femoral as strongest for mortality and renal outcomes. In conclusion, central cannulation may provide the most balanced risk profile in MICS, particularly in minimizing neurologic and vascular events, while femoral cannulation remains a valid alternative in patients without significant aortic disease. Axillary cannulation, despite its theoretical benefits, was associated with higher complication rates and warrants further prospective evaluation.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting LVEF After PCI and its Effect on Clinical Outcomes in Patients With Stable Ischemic Cardiomyopathy and LVEF≤50.","authors":"Stephen G Ellis, Ben Alencherry, Khaled Ziada, Jacqueline Tamis-Holland, Evan Whitehead, Wilson Tang","doi":"10.1016/j.amjcard.2025.09.004","DOIUrl":"10.1016/j.amjcard.2025.09.004","url":null,"abstract":"<p><p>For most patients with stable ischemic cardiomyopathy (SICM), PCI neither improves LVEF nor heart failure outcomes. We sought to ascertain if specific subgroups of SICM patients might have a LVEF and clinical benefit from PCI. From a cohort of 1702 consecutive SICM patients with LVEF ≤50% treated between 2009 and 2023, patients were randomly selected for screening to meet final inclusion criteria including target vessel subtending ≥20% of the LV, hibernation+ischemia>scar, timely pre- and post PCI echos and no intercurrent treatment that might influence change in LVEF, until a cohort of 200 patients was available. Parsimoniously selected variables were then assessed for correlation with change in LVEF, with 1000-fold bootstrapping to minimize overfitting. Correlation of change in LVEF with freedom from cardiac death or heart failure admission was assessed with Cox multivariable analysis. Mean age was 69 ± 10 yrs, 76% were male, 52% had diabetes and baseline LVEF obtained a median 9 days before PCI was 35% ± 11%. Post-PCI LVEF obtained at a median 132 days was 39% ± 11%. Median follow-up was 35 months. After consideration of medication usage, the presence of an ICD, baseline LVEF >35%, prior CABG and scar all were independently and negatively correlated with improvement in LVEF (p ≤0.035). Patients with none of these factors had an improvement in LVEF of 5.5% ± 7.4%. Post-PCI LVEF and change in LVEF were independently correlated with reduced risk of clinical events (p = 0.003 and p = 0.032, respectively). If validated, these data will change the paradigm that no patients with SICM have a heart failure or mortality benefit from PCI.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation Worsens Right Ventricular Dysfunction and Outcomes in Acute Pulmonary Embolism.","authors":"Quinn Mallery, Myoung Hyun Choi, Simran Koura, Frances Greathouse, Jacob Clark, Neel Gadhoke, Aishwarya Sharma, Ahmed Elkaryoni, Parth Desai, Yevgeniy Brailovsky, Amir Darki","doi":"10.1016/j.amjcard.2025.09.045","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.045","url":null,"abstract":"<p><p>Atrial fibrillation (AF), both new-onset and preexisting, is associated with increased mortality in acute pulmonary embolism (PE). However, the underlying mechanism, whether through increased right ventricular dysfunction (RVD) or an alternative pathway, is less well understood. We conducted a retrospective, multi-center cohort study using data from our institutional Pulmonary Embolism Response Team (PERT) registry. Adults (age >18 years) with a PERT activation and a transthoracic echocardiogram (TTE) performed within 3 days of PE diagnosis were included. Patients were stratified by AF status (no AF vs. preexisting or new-onset). TTE images were independently reviewed to assess for RVD. Outcomes were analyzed using univariate testing, multivariate regression, and Cox proportional hazards modeling. Among 785 patients with acute PE, 16% had AF. Compared with those without AF, patients with AF had higher unadjusted rates of RVD (33% vs. 24%, p=0.021) and significant differences in individual parameters including TAPSE (1.72 vs. 1.9 cm, p=0.006), S' (11.3 vs. 13.4 cm/s, p<0.0001) and RVOT VTI (12.5 vs. 13.9 cm, p=0.006). In adjusted analyses, AF remained significantly associated with RVD (OR 1.95, 95% CI 1.27-2.98, p=0.002), inpatient mortality (OR 2.58, p=0.03), acute renal failure (OR 1.75, p=0.017), and one-year mortality (HR 1.66, p=0.02). These findings provide further evidence for the adverse prognostic impact of AF on acute PE mortality and suggest that RVD may be a key mediator. AF should be considered in acute PE risk stratification, and further studies are needed to evaluate targeted treatment strategies in this population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Diabetes Mellitus on 5-year Outcomes after PCI with a Polymer-Free Drug-Coated Stent or a Biodegradable Polymer Ultra-thin Strut Stent.","authors":"Kirstine Nørregaard Hansen, Evald Høj Christiansen, Julia Ellert-Gregersen, Ashkan Eftekhari, Lars Jakobsen, Karsten T Veien, Phillip Freeman, Rebekka Vibjerg Jensen, Manijeh Noori, Nicolaj Brejnholt Støttrup, Jens Flensted Lassen, Jens Trøan, Michael Maeng, Christian Juhl Terkelsen, Bent Raungaard, Johnny Kahlert, Anders Junker, Lisette Okkels Jensen","doi":"10.1016/j.amjcard.2025.09.048","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.048","url":null,"abstract":"<p><strong>Objectives: </strong>Diabetes mellitus (DM) is a known risk factor for cardiac events in patients undergoing percutaneous coronary intervention (PCI). It remains unclear whether specific stent types improve long-term outcomes in this population. This substudy of the Scandinavian Organization for Randomized Trials with Clinical Outcome (SORT OUT) IX trial compared long-term outcomes in patients with DM with either the polymer-free biolimus A9-coated BioFreedom stent (BF-BES) or the ultra-thin strut, biodegradable polymer sirolimus-eluting Orsiro stent (O-SES).</p><p><strong>Methods: </strong>SORTOUT IX was a randomized, non-inferiority trial allocating patients to BF-BES or O-SES. The primary endpoints was target lesion failure (TLF), consisting of cardiac death, target lesion-related myocardial infarction (MI), and target lesion revascularization (TLR), and stent thrombosis within 5 years in patients with DM.</p><p><strong>Results: </strong>Among 3,151 patients enrolled, 607 (19.3%) had DM (BF-BES: 304; O-SES: 303). At 5-year, TLF was higher for patients with DM than those without DM (19.9% vs. 11.4%, rate ratio (RR) 1.48; 95% confidence interval (CI) 1.15-1.91). In patients with DM, TLF was similar between BF-BES and O-SES (21.7% vs. 18.2%; RR 1.11; 95% CI; 0.76-1.62). Rates of cardiac death, TLR and stent thrombosis did not differ significantly. In-stent restenosis was higher for BF-BES within 1 year (4.6% vs. 1.0%; RR 4.20; 95% CI 1.20-14.7), but not after 5 years (5.9% vs. 10.2%; RR 1.56; 95 % CI 0.85-2.85).</p><p><strong>Conclusion: </strong>In patient with DM undergoing PCI, rates of TLF, cardiac death, target MI, TLR and stent thrombosis did not differ between BF-BES and O-SES after 5 years.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global and Regional Trends in Hypertensive Heart Disease-Related Mortality: Insight from World Health Organization Database.","authors":"Vikash Jaiswal, Faisal Chowdhury, Yusra Mashkoor, Yusra Minahil Nasir, Vamsi Garimella, Jef Van den Eynde, Helen Ye Rim Huang, Muhammad Hanif, Kriti Kalra, Wilbert Aronow, Gregg C Fonarow","doi":"10.1016/j.amjcard.2025.09.025","DOIUrl":"10.1016/j.amjcard.2025.09.025","url":null,"abstract":"<p><p>Hypertensive heart disease (HHD) remains one of the leading causes of cardiovascular morbidity and mortality across the globe. Unbalanced lifestyle, dietary patterns, and lack of awareness caused an increase in HHD and associated mortality. This study aims to explore global mortality trends in HHD patients and examines the disparities based on sex and regions across the globe. We obtained mortality data from the World Health Organization Mortality Database for HHD from 2000 to 2019. Crude (CMR) and age-standardized mortality rates (ASMR) per 100,000 individuals were calculated, and trends in average annual percentage change (AAPC) were analyzed using joinpoint regression. The analysis included 117 countries across 6 regions. There was a significant increase in global mortality associated with hypertensive disorder. CMR increased from 10.60 to 16.74 per 100,000 population (AAPC: 2.46%, 95% CI: 2.22% to 2.69%). While ASMR displayed a more modest increase (AAPC: 0.54%, 95% CI: 0.06% to 1.03%). There were also significant regional and sex-based variations in the mortality rate. North America and the Caribbean exhibited the highest increase in CMR (AAPC: 3.11%), while Asia displayed the highest ASMR in 2019 (15.01). ASMR also increased significantly in North America and the Caribbean (AAPC: 1.72%, 95% CI: 1.64% to 1.80%), and decreased in Europe (AAPC: -0.56%, 95% CI: -0.85% to -0.26%). Although females showed higher CMR overall, ASMR were higher in males (AAPC: 0.71%, 95% CI: 0.21% to 1.22%). In conclusion, HHD mortality rose globally from 2000 to 2019, with CMR and ASMR showing marked regional, age, and sex-specific disparities. North America and Asia exhibited the steepest increases, especially among older adults. Across all the regions, females had higher CMR, but males showed higher ASMR and steeper annual increases. Combined, these results suggest the need to improve region- and sex-specific public health initiatives targeted at blood pressure control.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Pulmonary Hypertension and Associated Right Ventricular Dysfunction.","authors":"Janet I Ma, Ndidi Owunna, Louisa A Mounsey, Nona M Jiang, Xiaodan Huo, Emily Zern, Jenna N McNeill, Emily S Lau, Eugene Pomerantsev, Michael H Picard, Dongyu Wang, Jennifer E Ho","doi":"10.1016/j.amjcard.2025.09.046","DOIUrl":"10.1016/j.amjcard.2025.09.046","url":null,"abstract":"<p><p>Prior studies have established the impact of sex differences on pulmonary arterial hypertension (PAH). However, it remains unclear whether these sex differences extend to other hemodynamic subtypes of pulmonary hypertension (PH). We examined sex differences in PH and hemodynamic PH subtypes in a hospital-based cohort of individuals who underwent right heart catheterization (RCH) between 2005 and 2016. We utilized multivariable linear regression to assess the association of sex with hemodynamic indices of right ventricle (RV) function (PA pulsatility index [PAPi], RV stroke work index [RVSWI], and right atrial: pulmonary capillary wedge pressure ratio [RA:PCWP]). We then used Cox regression models to examine the association between sex and clinical outcomes among those with PH. Among 5,208 individuals with PH (mean age 64 years, 39% women), there was no significant sex difference in prevalence of PH. However, when stratified by PH subtype, 31% of women versus 22% of men had precapillary (p <0.001), 39% versus 51% had postcapillary (p <0.001), and 30% versus 27% had mixed PH (p = 0.15). Female sex was associated with better RV function by hemodynamic indices, including higher PAPi and RVSWI (p <0.001 for both). Over 7.3 years of follow-up, female sex was associated with a lower risk of heart failure hospitalization (HR 0.83, 95% CI 0.74 to 0.91, p <0.001). In conclusion, across a broad hospital-based sample, more women had precapillary and more men had postcapillary PH. Compared with men, women with PH had better hemodynamic indices of RV function and a lower risk of heart failure (HF) hospitalization.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is FFR Better Than iFR for Left Main Assessment?","authors":"Arnold Seto, Derek Antoku","doi":"10.1016/j.amjcard.2025.09.027","DOIUrl":"10.1016/j.amjcard.2025.09.027","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Patients with HFrEF; Overcoming Clinical Inertia.","authors":"Iain Squire","doi":"10.1016/j.amjcard.2025.09.028","DOIUrl":"10.1016/j.amjcard.2025.09.028","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning Predicts Cardiac Output from Seismocardiographic Signals in Heart Failure.","authors":"Jesse Wang, Seyed M Nouraie, Neil J Kelly, Stephen Y Chan","doi":"10.1016/j.amjcard.2025.09.037","DOIUrl":"10.1016/j.amjcard.2025.09.037","url":null,"abstract":"<p><p>Determination of cardiac output (CO) is essential to the clinical management of cardiovascular compromise. However, the invasiveness, procedural risks, and reliance on specialized infrastructure limit accessibility and scalability of standard-of-care right heart catheterization (RHC). Seismocardiography (SCG), a non-invasive technique which records subtle chest wall vibrations generated by cardiac mechanical activity, may offer a promising alternative for CO determination. To develop and evaluate a deep learning model for estimating CO directly from SCG, electrocardiogram (ECG), and body mass index (BMI) in heart failure patients undergoing RHC. We trained a deep convolutional neural network for CO estimation using an open-access dataset comprising 73 heart failure patients with simultaneous RHC, SCG, and ECG recordings. Model performance was evaluated on 64 patients using pairwise nested leave-pair-out cross-validation. When estimating CO in patients with a reference output < 6 L/min, the deep learning model achieved a mean bias of -0.01 L/min with LoA from -0.88 to 0.87 L/min. When predicting cardiac index in patients with a reference index < 2.2 L/min/m², the model yielded a mean bias of 0.07 L/min/m² with LoA from -0.35 to 0.48 L/min/m². This study demonstrates the feasibility of using deep learning in combination with wearable SCG sensors to non-invasively estimate CO. Model performance was particularly strong in low-output states. These findings highlight the potential of SCG-based monitoring to augment clinical decision-making in settings where invasive measurements are impractical or unavailable. Prospective multicenter validation is needed to confirm generalizability and assess clinical impact.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}