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Возможности магнитно-резонансной томографии в выявлении ранних морфофункциональных изменений миокарда у молодых лиц с сахарным диабетом 1-го типа
Попов К.А., Бондаренко И.З., Бирюкова Е.В. и др. Возможности магнитно-резонансной томографии в выявлении ранних морфофункциональных изменений миокарда у молодых лиц с сахарным диабетом 1-го типа. CardioСоматика. 2019; 10 (1): 29–35. DOI: 10.26442/22217185.2019.1.180172
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Popov K.A., Bondarenko I.Z., Biryukova E.V. et al. Magnetic resonance imaging can diagnostic early morphofunctional changes in the myocardium in young people with type 1 diabetes. Cardiosomatics. 2019; 10 (1): 29–35. DOI: 10.26442/22217185.2019.1.180172
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Аннотация
Цель. Изучить морфофункциональное состояние миокарда у молодых лиц с сахарным диабетом 1-го типа (СД 1) при помощи технологий магнитно-резонансной томографии (МРТ).
Материалы и методы. В исследование включены 38 (14 мужчин, 24 женщины) пациентов в возрасте от 18 до 36 лет со стажем заболевания СД 1 от 5 до 16 лет, которым выполнено МРТ сердца с контрастированием. Критериями исключения являлись: выраженные нарушения электролитного состава крови, диспротеинемия, хроническая печеночная и почечная недостаточность – скорость клубочковой фильтрации (СКФ) по формуле EPI≤60 мл/мин/1,73 м2, нарушения функции щитовидной железы, ожирение (индекс массы тела 30 кг/м2 и более), диагностированные сердечно-сосудистые заболевания, противопоказания к выполнению МРТ. Получены показатели функциональных изменений левого желудочка (циркулярный стрейн, индекс релаксации стрейна – ИРС, пиковая скорость раннего диастолического стрейна – ПСРДС), проведена оценка зон накопления контрастного препарата в отсроченном периоде.
Результаты. Полученные результаты стрейна, ИРС, ПСРДС не позволяют исключить наличие функциональных изменений миокарда левого желудочка. У 42,11% визуализировались зоны накопления контрастного препарата в отсроченном периоде (незначительное – 28,95% и умеренное накопление – 13,16%) преимущественно эндокардом клапанного аппарата сердца (митральный и трикуспидальный), а в одном наблюдении (2,9%) – в сочетании с невыраженной диффузной неоднородностью миокарда левого желудочка.
Вывод. МРТ сердца является перспективным направлением в оценке ранних морфофункциональных изменений структуры миокарда, что, вероятно, позволит спрогнозировать жизнеугрожающие изменения сердечной мышцы у молодых пациентов с СД 1.
Ключевые слова: сахарный диабет, магнитно-резонансная томография сердца, стрейн, зоны накопления контрастного препарата.
Материалы и методы. В исследование включены 38 (14 мужчин, 24 женщины) пациентов в возрасте от 18 до 36 лет со стажем заболевания СД 1 от 5 до 16 лет, которым выполнено МРТ сердца с контрастированием. Критериями исключения являлись: выраженные нарушения электролитного состава крови, диспротеинемия, хроническая печеночная и почечная недостаточность – скорость клубочковой фильтрации (СКФ) по формуле EPI≤60 мл/мин/1,73 м2, нарушения функции щитовидной железы, ожирение (индекс массы тела 30 кг/м2 и более), диагностированные сердечно-сосудистые заболевания, противопоказания к выполнению МРТ. Получены показатели функциональных изменений левого желудочка (циркулярный стрейн, индекс релаксации стрейна – ИРС, пиковая скорость раннего диастолического стрейна – ПСРДС), проведена оценка зон накопления контрастного препарата в отсроченном периоде.
Результаты. Полученные результаты стрейна, ИРС, ПСРДС не позволяют исключить наличие функциональных изменений миокарда левого желудочка. У 42,11% визуализировались зоны накопления контрастного препарата в отсроченном периоде (незначительное – 28,95% и умеренное накопление – 13,16%) преимущественно эндокардом клапанного аппарата сердца (митральный и трикуспидальный), а в одном наблюдении (2,9%) – в сочетании с невыраженной диффузной неоднородностью миокарда левого желудочка.
Вывод. МРТ сердца является перспективным направлением в оценке ранних морфофункциональных изменений структуры миокарда, что, вероятно, позволит спрогнозировать жизнеугрожающие изменения сердечной мышцы у молодых пациентов с СД 1.
Ключевые слова: сахарный диабет, магнитно-резонансная томография сердца, стрейн, зоны накопления контрастного препарата.
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Aim. To study the morphofunctional state of the myocardium in young people with diabetes mellitus 1 using magnetic resonance imaging (MRI) technology.
Materials and methods. 38 patients (14 men, 24 women), aged 18 to 36 years old, with an experience of type 1 diabetes from 5 to 16 years old were underwent contrastive MRI of the heart. The exclusion criteria were: pronounced electrolyte disorders in the blood, dysproteinemia, chronic liver and kidney failure – glomerular filtration rate (EPI)≤60 ml/min/1.73 m2, thyroid dysfunction, obesity (body mass index ≥30 kg/m2), diagnosed cardiovascular diseases, contraindications for MRI. The indicators of functional changes in the left ventricle (circular strain, strain relaxation index – SRI), peak early diastolic strain (PSRDS) were obtained and the accumulation of the contrast agent in the delayed period were assessed.
Results. The obtained results of strain, SRI, PSRDS do not allow to exclude the presence of functional changes in the myocardium of the left ventricle. In 42.11%, zones of accumulation of the contrast agent were visualized in the delayed period (insignificant – 28.95% and moderate accumulation – 13.16%), mainly by the endocardium of the cardiac apparatus (mitral and tricuspid), and in one observation (2.9%) – in combination with unexpressed diffuse heterogeneity of the myocardium of the left ventricle.
Conclusion. MRI of the heart is a promising direction in the assessment of early morphofunctional changes in the structure of the myocardium, which will probably make it possible to predict life-threatening changes in the heart muscle in young patients with type 1 diabetes.
Key words: diabetes mellitus, magnetic resonance imaging of the heart, strain, zone of accumulation of a contrast agent.
Полный текст
Список литературы
1. Armstrong AC, Ambale-Venkatesh B, Turkbey E et al. Association of сardiovascular risk factors and myocardial fibrosis with early cardiac dysfunction in type 1 diabetes: The Diabetes Control and Complications Trial. Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2016; 16: 1889.
2. Matsushita K, Blecker S, Pazin-Filho A et al. The association of hemoglobin A1c with incident heart failure among people without diabetes: The atherosclerosis risk in communities study. Diabetes 2010; 59: 2020–6.
3. Maftei O, Pena AS, Sullivan T et al. AdDIT Study Group Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: Adolescent type 1 Diabetes cardiorenal Intervention Trial (AdDIT). Diabetes Care 2014; 37: 3069–75.
4. Cho YH, Craig ME, Davis EA et al. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial. Cardiac autonomic dysfunction is associated with high-risk albumin-to-creatinine ratio in young adolescents with type 1 diabetes in AdDIT (adolescent type 1 diabetes cardio-renal).
5. Bjornstad P, Maahs DM, Duca LM. Estimated insulin sensitivity predicts incident micro- and macrovascular complications in adults with type 1 diabetes over 6 years: the coronary artery calcification in type 1 diabetes study. J Diabet Complications 2016; 30 (4): 586–90.
6. Bando YK, Murohara T. Diabetes-related heart failure. Circ J 2014; 78 (3): 576–83.
7. Gill GV, Woodward A, Casson IF et al. Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes – the “dead in bed” syndrome revisited. Diabetologia 2009; 52 (1): 42.
8. Hsieh A, Twigg SM. The enigma of the dead-in-bed syndrome: challenges in predicting and preventing this devastating complication of type 1 diabetes. J Diabet Complications 2014; 28 (5): 585–7.
9. Atsuko M, Satoshi Y, Kazufumi T et al. Quantitative assessment of left ventricular and left atrial functions by strain rate imaging in diabetic patients with and without hypertension. J CV Ultrasound. Allied Tech 2009; 26: 262–71.
10. Onishi T, Saha SK, Delgado-Montero A et al. Global longitudinal strain and global circumferential strain by speckle-tracking echocardiography and feature-tracking cardiac magnetic resonance imaging: comparison with left ventricular ejection fraction. J Am Soc Echocardiogr 2015; 28: 587–96.
11. Kosmala W, Jellis CL, Marwick TH. Exercise limitation associated with asymptomatic left ventricular impairment: analogy with stage B heart failure. J Am Coll Cardiol 2015; 65 (3): 257–66.
12. Uzieblo-Zyczkowska B, Krzesinski P, Gielerak G et al. Speckle tracking echocardiography and tissue Doppler imaging reveal beneficial effect of pharmacotherapy in hypertensives with asymptomatic left ventricular dysfunction. J Am Soc Hypertens 2017; 11 (6): 334–42.
13. Smiseth OA, Torp H, Opdahl A et al. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 2016; 37 (15): 1196–207.
14. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014; 100 (21): 1673–80.
15. Nagueh SF, Smiseth OA, Appleton CP et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the ASE and the EACI. J Am Soc Echocardiogr 2016; 29: 277–314.
16. Yurdakul S, Dogan A, Aytekin S. Assessment of subclinical left ventricular systolic function using strain imaging in the follow-up of patients with chronic mitral regurgitation. Turk Kardiyol Dern Ars 2017; 45 (5): 426–33.
17. European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the ESC and other societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the EACPR. Eur Heart J 2016; 37: 2315–81.
18. Ganame J, Messalli G, Masci PG. Time course of infarct healing and left ventricular remodeling in patients with reperfused ST-segment elevation myocardial infarction using compre-hensive magnetic resonance imaging. Eur Radiol 2011; 21 (4): 693–701.
19. Ambale-Venkatesh B, Lima JAC. Cardiac MRI: a central prognostic tool in myocardial fibrosis. Nature Rev Cardiol 2015; 12 (1): 18–29.
20. Ambale-Venkatesh B, Armstrong, AC, Liu CY et al. Diastolic function assessed from tagged MRI predicts heart failure and atrial fibrillation over an 8-year follow-up period: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imag 2013; 15 (4): 442–9.
21. Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER et al. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magnetic Res 2015; 17 (1): 29.
22. Takigiku K, Takeuchi M, Izumi C et al. Normal Range of Left Ventricular 2-Dimensional Strain. Japanese Ultrasound Speckle Tracking of the Left Ventricle Study. Circ J 2012; 76 (11): 2623–32.
23. Muraru D, Cucchini U, Mihăilă S et al. Left ventricular myocardial strain by three-dimensional speckle-tracking echocardiography in healthy subjects: reference values and analysis of their physiologic and technical determinants. J Am Soc Echocardiogr 2014; 27 (8): 858–71.
2. Matsushita K, Blecker S, Pazin-Filho A et al. The association of hemoglobin A1c with incident heart failure among people without diabetes: The atherosclerosis risk in communities study. Diabetes 2010; 59: 2020–6.
3. Maftei O, Pena AS, Sullivan T et al. AdDIT Study Group Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: Adolescent type 1 Diabetes cardiorenal Intervention Trial (AdDIT). Diabetes Care 2014; 37: 3069–75.
4. Cho YH, Craig ME, Davis EA et al. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial. Cardiac autonomic dysfunction is associated with high-risk albumin-to-creatinine ratio in young adolescents with type 1 diabetes in AdDIT (adolescent type 1 diabetes cardio-renal).
5. Bjornstad P, Maahs DM, Duca LM. Estimated insulin sensitivity predicts incident micro- and macrovascular complications in adults with type 1 diabetes over 6 years: the coronary artery calcification in type 1 diabetes study. J Diabet Complications 2016; 30 (4): 586–90.
6. Bando YK, Murohara T. Diabetes-related heart failure. Circ J 2014; 78 (3): 576–83.
7. Gill GV, Woodward A, Casson IF et al. Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes – the “dead in bed” syndrome revisited. Diabetologia 2009; 52 (1): 42.
8. Hsieh A, Twigg SM. The enigma of the dead-in-bed syndrome: challenges in predicting and preventing this devastating complication of type 1 diabetes. J Diabet Complications 2014; 28 (5): 585–7.
9. Atsuko M, Satoshi Y, Kazufumi T et al. Quantitative assessment of left ventricular and left atrial functions by strain rate imaging in diabetic patients with and without hypertension. J CV Ultrasound. Allied Tech 2009; 26: 262–71.
10. Onishi T, Saha SK, Delgado-Montero A et al. Global longitudinal strain and global circumferential strain by speckle-tracking echocardiography and feature-tracking cardiac magnetic resonance imaging: comparison with left ventricular ejection fraction. J Am Soc Echocardiogr 2015; 28: 587–96.
11. Kosmala W, Jellis CL, Marwick TH. Exercise limitation associated with asymptomatic left ventricular impairment: analogy with stage B heart failure. J Am Coll Cardiol 2015; 65 (3): 257–66.
12. Uzieblo-Zyczkowska B, Krzesinski P, Gielerak G et al. Speckle tracking echocardiography and tissue Doppler imaging reveal beneficial effect of pharmacotherapy in hypertensives with asymptomatic left ventricular dysfunction. J Am Soc Hypertens 2017; 11 (6): 334–42.
13. Smiseth OA, Torp H, Opdahl A et al. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 2016; 37 (15): 1196–207.
14. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014; 100 (21): 1673–80.
15. Nagueh SF, Smiseth OA, Appleton CP et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the ASE and the EACI. J Am Soc Echocardiogr 2016; 29: 277–314.
16. Yurdakul S, Dogan A, Aytekin S. Assessment of subclinical left ventricular systolic function using strain imaging in the follow-up of patients with chronic mitral regurgitation. Turk Kardiyol Dern Ars 2017; 45 (5): 426–33.
17. European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the ESC and other societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the EACPR. Eur Heart J 2016; 37: 2315–81.
18. Ganame J, Messalli G, Masci PG. Time course of infarct healing and left ventricular remodeling in patients with reperfused ST-segment elevation myocardial infarction using compre-hensive magnetic resonance imaging. Eur Radiol 2011; 21 (4): 693–701.
19. Ambale-Venkatesh B, Lima JAC. Cardiac MRI: a central prognostic tool in myocardial fibrosis. Nature Rev Cardiol 2015; 12 (1): 18–29.
20. Ambale-Venkatesh B, Armstrong, AC, Liu CY et al. Diastolic function assessed from tagged MRI predicts heart failure and atrial fibrillation over an 8-year follow-up period: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imag 2013; 15 (4): 442–9.
21. Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER et al. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magnetic Res 2015; 17 (1): 29.
22. Takigiku K, Takeuchi M, Izumi C et al. Normal Range of Left Ventricular 2-Dimensional Strain. Japanese Ultrasound Speckle Tracking of the Left Ventricle Study. Circ J 2012; 76 (11): 2623–32.
23. Muraru D, Cucchini U, Mihăilă S et al. Left ventricular myocardial strain by three-dimensional speckle-tracking echocardiography in healthy subjects: reference values and analysis of their physiologic and technical determinants. J Am Soc Echocardiogr 2014; 27 (8): 858–71.
________________________________________________
1. Armstrong AC, Ambale-Venkatesh B, Turkbey E et al. Association of сardiovascular risk factors and myocardial fibrosis with early cardiac dysfunction in type 1 diabetes: The Diabetes Control and Complications Trial. Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2016; 16: 1889.
2. Matsushita K, Blecker S, Pazin-Filho A et al. The association of hemoglobin A1c with incident heart failure among people without diabetes: The atherosclerosis risk in communities study. Diabetes 2010; 59: 2020–6.
3. Maftei O, Pena AS, Sullivan T et al. AdDIT Study Group Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: Adolescent type 1 Diabetes cardiorenal Intervention Trial (AdDIT). Diabetes Care 2014; 37: 3069–75.
4. Cho YH, Craig ME, Davis EA et al. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial. Cardiac autonomic dysfunction is associated with high-risk albumin-to-creatinine ratio in young adolescents with type 1 diabetes in AdDIT (adolescent type 1 diabetes cardio-renal).
5. Bjornstad P, Maahs DM, Duca LM. Estimated insulin sensitivity predicts incident micro- and macrovascular complications in adults with type 1 diabetes over 6 years: the coronary artery calcification in type 1 diabetes study. J Diabet Complications 2016; 30 (4): 586–90.
6. Bando YK, Murohara T. Diabetes-related heart failure. Circ J 2014; 78 (3): 576–83.
7. Gill GV, Woodward A, Casson IF et al. Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes – the “dead in bed” syndrome revisited. Diabetologia 2009; 52 (1): 42.
8. Hsieh A, Twigg SM. The enigma of the dead-in-bed syndrome: challenges in predicting and preventing this devastating complication of type 1 diabetes. J Diabet Complications 2014; 28 (5): 585–7.
9. Atsuko M, Satoshi Y, Kazufumi T et al. Quantitative assessment of left ventricular and left atrial functions by strain rate imaging in diabetic patients with and without hypertension. J CV Ultrasound. Allied Tech 2009; 26: 262–71.
10. Onishi T, Saha SK, Delgado-Montero A et al. Global longitudinal strain and global circumferential strain by speckle-tracking echocardiography and feature-tracking cardiac magnetic resonance imaging: comparison with left ventricular ejection fraction. J Am Soc Echocardiogr 2015; 28: 587–96.
11. Kosmala W, Jellis CL, Marwick TH. Exercise limitation associated with asymptomatic left ventricular impairment: analogy with stage B heart failure. J Am Coll Cardiol 2015; 65 (3): 257–66.
12. Uzieblo-Zyczkowska B, Krzesinski P, Gielerak G et al. Speckle tracking echocardiography and tissue Doppler imaging reveal beneficial effect of pharmacotherapy in hypertensives with asymptomatic left ventricular dysfunction. J Am Soc Hypertens 2017; 11 (6): 334–42.
13. Smiseth OA, Torp H, Opdahl A et al. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 2016; 37 (15): 1196–207.
14. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014; 100 (21): 1673–80.
15. Nagueh SF, Smiseth OA, Appleton CP et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the ASE and the EACI. J Am Soc Echocardiogr 2016; 29: 277–314.
16. Yurdakul S, Dogan A, Aytekin S. Assessment of subclinical left ventricular systolic function using strain imaging in the follow-up of patients with chronic mitral regurgitation. Turk Kardiyol Dern Ars 2017; 45 (5): 426–33.
17. European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the ESC and other societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the EACPR. Eur Heart J 2016; 37: 2315–81.
18. Ganame J, Messalli G, Masci PG. Time course of infarct healing and left ventricular remodeling in patients with reperfused ST-segment elevation myocardial infarction using compre-hensive magnetic resonance imaging. Eur Radiol 2011; 21 (4): 693–701.
19. Ambale-Venkatesh B, Lima JAC. Cardiac MRI: a central prognostic tool in myocardial fibrosis. Nature Rev Cardiol 2015; 12 (1): 18–29.
20. Ambale-Venkatesh B, Armstrong, AC, Liu CY et al. Diastolic function assessed from tagged MRI predicts heart failure and atrial fibrillation over an 8-year follow-up period: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imag 2013; 15 (4): 442–9.
21. Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER et al. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magnetic Res 2015; 17 (1): 29.
22. Takigiku K, Takeuchi M, Izumi C et al. Normal Range of Left Ventricular 2-Dimensional Strain. Japanese Ultrasound Speckle Tracking of the Left Ventricle Study. Circ J 2012; 76 (11): 2623–32.
23. Muraru D, Cucchini U, Mihăilă S et al. Left ventricular myocardial strain by three-dimensional speckle-tracking echocardiography in healthy subjects: reference values and analysis of their physiologic and technical determinants. J Am Soc Echocardiogr 2014; 27 (8): 858–71.
Авторы
К.А.Попов*1,2, И.З.Бондаренко1, Е.В.Бирюкова2, Е.В.Аверкиева1, А.В.Воронцов1
1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России. 117036, Россия, Москва, ул. Дмитрия Ульянова, д. 11;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*mbinfakare@mail.ru
1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России. 117036, Россия, Москва, ул. Дмитрия Ульянова, д. 11;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*mbinfakare@mail.ru
________________________________________________
Kirill A. Popov*1,2, Irina Z. Bondarenko1, Elena V. Biryukova2, Elena V. Averkieva1, Alexander V. Vorontsov1
1 Endocrinology Research Center of the Ministry of Health of the Russian Federation. 11, Dmitria Ul'ianova st., Moscow, 117036, Russian Federation;
2 A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 1, 20, Delegatskaia st., Moscow, 127473, Russian Federation
*mbinfakare@mail.ru
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