Publications by authors named "Jerome Roncalli"

117 Publications

Prevalence of Posttranscatheter Aortic Valve Implantation Vascular Complications in Real Life.

J Interv Cardiol 2021 12;2021:5563486. Epub 2021 Oct 12.

Department of Cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France.

Background: Vascular complications (VCs) are commonly observed after transfemoral transcatheter aortic valve implantation (TAVI) procedures. Closure devices for the access site were developed to reduce their incidence. We aim to evaluate the prevalence, predictors, and outcomes of the occurrence of post-TAVI VCs.

Materials And Methods: A retrospective study was conducted on 1336 consecutive patients who underwent TAVI at the University Hospital of Toulouse, France, between January 2016 and March 2020. All included procedures were performed through the common femoral artery, and ProGlide was the used closure device. The studied population was divided into two groups depending on the occurrence of VCs defined according to Valve Academic Research Consortium-2 criteria.

Results: The mean age of the studied population was 84.4 ± 6.9, and 48% were male. 90% of TAVI interventions were performed through the right femoral artery. The prevalence of VCs was 18.8%, and 3.7% were major. Prolonged procedure duration was an independent predictor of VCs. Using the right access site and smaller introducer size (14 Fr) were preventive factors. No significant difference in mortality rate was detected between the two groups.

Conclusion: This study showed a low prevalence for post-TAVI VCs, especially for the major type. An increase in bleeding events and prolonged cardiac care unit stay were the common adverse outcomes.
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http://dx.doi.org/10.1155/2021/5563486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8526196PMC
November 2021

Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter.

J Clin Med 2021 Sep 29;10(19). Epub 2021 Sep 29.

Department of Cardiology, University Hospital Rangueil, 31400 Toulouse, France.

Background and objectives Severe forms of Tachycardia-induced cardiomyopathy (TIC) with cardiogenic shock are not well described so far, and efficiency of catheter ablation in this setting is unknown. Methods We retrospectively included consecutive patients admitted to the Intensive Cardiac Care Unit for acute heart failure with cardiogenic shock associated with atrial arrhythmia and managed by ablation. Result Fourteen patients were included, each with cardiogenic shock and two needing the use of extracorporeal membrane oxygenation. Successful ablation was performed in the acute setting or over the following weeks. Two patients experienced relapses of arrhythmias and were treated by new ablation procedures. At 7.5 ± 5 months follow-up, all patient were alive with stable sinus rhythm. The left ventricular Ejection Fraction dramatically improved (21 vs. 54%, = 0.001) as well as the end-diastolic left ventricular diameter (61 vs. 51 mm, = 0.01) and NYHA class (class IV in all vs. median 1, = 0.002). Conclusion Restoration and maintenance of sinus rhythm in severe TIC with cardiogenic shock and atrial arrhythmias lead to a major increase or normalization of LVEF, reduction of ventricular dimensions, and improvement in functional status. Ablation is efficient in long-term maintenance of sinus rhythm and may be proposed early in refractory cases.
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http://dx.doi.org/10.3390/jcm10194504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509419PMC
September 2021

Vaccination for Respiratory Infections in Patients with Heart Failure.

J Clin Med 2021 Sep 22;10(19). Epub 2021 Sep 22.

Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France.

Bronchopulmonary infections are a major trigger of cardiac decompensation and are frequently associated with hospitalizations in patients with heart failure (HF). Adverse cardiac effects associated with respiratory infections, more specifically and influenza infections, are the consequence of inflammatory processes and thrombotic events. For both influenza and pneumococcal vaccinations, large multicenter randomized clinical trials are needed to evaluate their efficacy in preventing cardiovascular events, especially in HF patients. No study to date has evaluated the protective effect of the COVID-19 vaccine in patients with HF. Different guidelines recommend annual influenza vaccination for patients with established cardiovascular disease and also recommend pneumococcal vaccination in patients with HF. The Heart Failure group of the French Society of Cardiology recently strongly recommended vaccination against COVID-19 in HF patients. Nevertheless, the implementation of vaccination recommendations against respiratory infections in HF patients remains suboptimal. This suggests that a national health policy is needed to improve vaccination coverage, involving not only the general practitioner, but also other health providers, such as cardiologists, nurses, and pharmacists. This review first summarizes the pathophysiology of the interrelationships between inflammation, infection, and HF. Then, we describe the current clinical knowledge concerning the protective effect of vaccines against respiratory diseases (influenza, pneumococcal infection, and COVID-19) in patients with HF and finally we propose how vaccination coverage could be improved in these patients.
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http://dx.doi.org/10.3390/jcm10194311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509310PMC
September 2021

Coronary artery aneurysm: A review.

World J Cardiol 2021 Sep;13(9):446-455

Department of Cardiology, University Hospital of Toulouse/Institute Cardiomet, Toulouse 31400, France.

Coronary artery aneurysm (CAA) is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment. Atherosclerosis is the main cause in adults and Kawasaki disease in children. CAA is a silent progressive disorder incidentally detected by coronary angiography, but it may end with fatal complications such as rupture, compression of adjacent cardiopulmonary structures, thrombus formation and distal embolization. The pathophysiological mechanisms are not well understood. Atherosclerosis, proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation. Data from previously published studies are scarce and controversial, thereby the management of CAA is individualized depending on clinical presentation, CAA characteristics, patient profile and physician experience. Multiple therapeutic approaches including medical treatment, covered stent angioplasty, coil insertion and surgery were described. Herein, we provide an up-to-date systematic review on the pathophysiology, complications and management of CAA.
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http://dx.doi.org/10.4330/wjc.v13.i9.446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462041PMC
September 2021

Management of myocardial infarction with Nonobstructive Coronary Arteries (MINOCA): a subset of acute coronary syndrome patients.

Rev Cardiovasc Med 2021 Sep;22(3):625-634

Department of Cardiology, Toulouse University Hospital, 31059 Toulouse, France.

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) represents a significant proportion (up to 15%) of acute myocardial infarction (AMI) population. MINOCA is diagnosed in patients who fullfilled the fourth universal definition of AMI in the absence of significant obstructive coronary artery disease on coronary angiography. MINOCA is a group of heterogeneous diseases with different pathophysiological mechanisms requiring multimodality imaging. Left ventriculography, cardiac magnetic resonance imaging and intra-coronary imaging (IVUS, OCT) are useful tools playing a pivotal role in the diagnostic work-up. There are no standard guidelines on the management of MINOCA patients and the therapeutic approach is personalized, thereby detecting the underlying aetiology is fundamental to initiate an early appropriate cause-targeted therapy.
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http://dx.doi.org/10.31083/j.rcm2203073DOI Listing
September 2021

Letter by Matta et al Regarding Article, "Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women".

Circulation 2021 Sep 20;144(12):e204. Epub 2021 Sep 20.

Department of Cardiology, CARDIOMET Institute, University Hospital of Toulouse, France (A.M., M.E., J.R.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.053041DOI Listing
September 2021

Metformin Attenuates Postinfarction Myocardial Fibrosis and Inflammation in Mice.

Int J Mol Sci 2021 Aug 30;22(17). Epub 2021 Aug 30.

National Institute of Health and Medical Research (INSERM) U1297, CEDEX 4, 31432 Toulouse, France.

Diabetes is a major risk factor for the development of cardiovascular disease with a higher incidence of myocardial infarction. This study explores the role of metformin, a first-line antihyperglycemic agent, in postinfarction fibrotic and inflammatory remodeling in mice. Three-month-old C57BI/6J mice were submitted to 30 min cardiac ischemia followed by reperfusion for 14 days. Intraperitoneal treatment with metformin (5 mg/kg) was initiated 15 min after the onset of reperfusion and maintained for 14 days. Real-time PCR was used to determine the levels of COL3A1, αSMA, CD68, TNF-α and IL-6. Increased collagen deposition and infiltration of macrophages in heart tissues are associated with upregulation of the inflammation-associated genes in mice after 14 days of reperfusion. Metformin treatment markedly reduced postinfarction fibrotic remodeling and CD68-positive cell population in mice. Moreover, metformin resulted in reduced expression of COL3A1, αSMA and CD68 after 14 days of reperfusion. Taken together, these results open new perspectives for the use of metformin as a drug that counteracts adverse myocardial fibroticand inflammatory remodeling after MI.
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http://dx.doi.org/10.3390/ijms22179393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430638PMC
August 2021

Left anterior descending myocardial bridge: Angiographic prevalence and its association to atherosclerosis.

Indian Heart J 2021 Jul-Aug;73(4):429-433. Epub 2021 Jan 19.

Department of Cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France. Electronic address:

Objective: Left anterior descending Myocardial Bridge (LADMB) is considered a benign condition and actually becomes a forgotten cause of serious cardiac events. This study was conducted to estimate the prevalence of LADMB and its association to atherosclerosis.

Methods: An observational retrospective study was conducted on patients referred for coronary angiography between June 2012 and June 2020. Coronary angiography database was revisedand studied population was divided into 2 groups: LADMB group versus Non-LADMB group.

Results: LADMB was detected in 510 patients out of 35813 included in the study resulting in a prevalence at 1.42%. The mean age was 66.5 years. Male gender was more common than female (70vs30%). The prevalence of significant atherosclerotic LAD disease was more than two times higher in the non-LADMB group compared to the LADMB group. Statistical analysis revealed a significant negative association between LADMB and atherosclerosis (p < 0.001). A significant greater rate of MINOCA cases was observed in acute coronary syndrome LADMB patients.

Conclusions: LADMB is an inborn anatomic variation associated to atherosclerotic risk reduction in LAD. Physicians must be aware about the potential complications and pay attention to those classified at high risk for cardiovascular events.
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http://dx.doi.org/10.1016/j.ihj.2021.01.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424261PMC
November 2021

Cardiac macrophage subsets differentially regulate lymphatic network remodeling during pressure overload.

Sci Rep 2021 08 19;11(1):16801. Epub 2021 Aug 19.

I2MC, Toulouse University, Inserm, Université Paul Sabatier, Toulouse, France.

The lymphatic network of mammalian heart is an important regulator of interstitial fluid compartment and immune cell trafficking. We observed a remodeling of the cardiac lymphatic vessels and a reduced lymphatic efficiency during heart hypertrophy and failure induced by transverse aortic constriction. The lymphatic endothelial cell number of the failing hearts was positively correlated with cardiac function and with a subset of cardiac macrophages. This macrophage population distinguished by LYVE-1 (Lymphatic vessel endothelial hyaluronic acid receptor-1) and by resident macrophage gene expression signature, appeared not replenished by CCR2 mediated monocyte infiltration during pressure overload. Isolation of macrophage subpopulations showed that the LYVE-1 positive subset sustained in vitro and in vivo lymphangiogenesis through the expression of pro-lymphangiogenic factors. In contrast, the LYVE-1 negative macrophage subset strongly expressed MMP12 and decreased the endothelial LYVE-1 receptors in lymphatic endothelial cells, a feature of cardiac lymphatic remodeling in failing hearts. The treatment of mice with a CCR2 antagonist during pressure overload modified the proportion of macrophage subsets within the pathological heart and preserved lymphatic network from remodeling. This study reports unknown and differential functions of macrophage subpopulations in the regulation of cardiac lymphatic during pathological hypertrophy and may constitute a key mechanism underlying the progression of heart failure.
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http://dx.doi.org/10.1038/s41598-021-95723-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376913PMC
August 2021

Left main coronary artery thrombus after cannabis consumption: a case report.

Eur Heart J Case Rep 2021 Jun 14;5(6):ytab179. Epub 2021 Jun 14.

Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, 1 Avenue Jean Poulhès, 31059 Toulouse, France.

Background: Left main coronary thrombus is a rare angiographic finding associated with serious outcomes such as sudden death and cardiogenic shock. Rupture of an underlying atherosclerotic plaque is the main risk factor. The role of cannabis consumption in the pathophysiology of acute cardiovascular disease is controversial.

Case Presentation: We present a case of non-ST-elevation myocardial infarction characterized by a mobile left main coronary thrombus in a young male cannabis consumer successfully treated with manual aspiration, dual anti-platelet, and unfractionated heparin therapy.

Conclusion: Cannabis consumption could be a risk factor for coronary artery thrombosis. The pathophysiology mechanism of action is not well understood. Reaching an optimal management is a potential challenge for physicians.
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http://dx.doi.org/10.1093/ehjcr/ytab179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244647PMC
June 2021

Surfing the clinical trials of mesenchymal stem cell therapy in ischemic cardiomyopathy.

Stem Cell Res Ther 2021 06 23;12(1):361. Epub 2021 Jun 23.

Department of Cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France.

While existing remedies failed to fully address the consequences of heart failure, stem cell therapy has been introduced as a promising approach. The present review is a comprehensive appraisal of the impacts of using mesenchymal stem cells (MSCs) in clinical trials mainly conducted on ischemic cardiomyopathy. The benefits of MSC therapy for dysfunctional myocardium are likely attributed to numerous secreted paracrine factors and immunomodulatory effects. The positive outcomes associated with MSC therapy are scar size reduction, reverse remodeling, and angiogenesis. Also, a decreasing in the level of chronic inflammatory markers of heart failure progression like TNF-α is observed. The intense inflammatory reaction in the injured myocardial micro-environment predicts a poor response of scar tissue to MSC therapy. Subsequently, the interval delay between myocardial injury and MSC therapy is not yet determined. The optimal requested dose of cells ranges between 100 to 150 million cells. Allogenic MSCs have different advantages compared to autogenic cells and intra-myocardial injection is the preferred delivery route. The safety and efficacy of MSCs-based therapy have been confirmed in numerous studies, however several undefined parameters like route of administration, optimal timing, source of stem cells, and necessary dose are limiting the routine use of MSCs therapeutic approach in clinical practice. Lastly, pre-conditioning of MSCs and using of exosomes mediated MSCs or genetically modified MSCs may improve the overall therapeutic effect. Future prospective studies establishing a constant procedure for MSCs transplantation are required in order to apply MSC therapy in our daily clinical practice and subsequently improving the overall prognosis of ischemic heart failure patients.
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http://dx.doi.org/10.1186/s13287-021-02443-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220796PMC
June 2021

Coronavirus disease vaccination in heart failure: No time to waste.

Arch Cardiovasc Dis 2021 05 24;114(5):434-438. Epub 2021 May 24.

Fédération des services de cardiologie, faculté de médecine, Institute CARDIOMET, Université Paul Sabatier-Toulouse III, CHU de Toulouse-Rangueil, 31059 Toulouse, France; UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, 31432 Toulouse, France.

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http://dx.doi.org/10.1016/j.acvd.2021.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141713PMC
May 2021

Transplantation of CD34+ cells for myocardial ischemia.

World J Transplant 2021 May;11(5):138-146

Department of Cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse 31059, France.

CD34+ cells are multipotent hematopoietic stem cells also known as endothelial progenitor cells and are useful in regenerative medicine. Naturally, these cells are mobilized from the bone marrow into peripheral circulation in response to ischemic tissue injury. CD34+ cells are known for their high proliferative and differentiation capacities that play a crucial role in the repair process of myocardial damage. They have an important paracrine activity in secreting factors to stimulate vasculogenesis, reduce endothelial cells and cardiomyocytes apoptosis, remodel extracellular matrix and activate additional progenitor cells. Once they migrate to the target site, they enhance angiogenesis, neovascularization and tissue regeneration. Several trials have demonstrated the safety and efficacy of CD34+ cell therapy in different settings, such as peripheral limb ischemia, stroke and cardiovascular disease. Herein, we review the potential utility of CD34+ cell transplantation in acute myocardial infarction, refractory angina and ischemic heart failure.
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http://dx.doi.org/10.5500/wjt.v11.i5.138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131931PMC
May 2021

Apilimod alters TGFβ signaling pathway and prevents cardiac fibrotic remodeling.

Theranostics 2021 19;11(13):6491-6506. Epub 2021 Apr 19.

INSERM U1297 I2MC, Toulouse, France and Université Paul Sabatier, Toulouse, France.

TGFβ signaling pathway controls tissue fibrotic remodeling, a hallmark in many diseases leading to organ injury and failure. In this study, we address the role of Apilimod, a pharmacological inhibitor of the lipid kinase PIKfyve, in the regulation of cardiac pathological fibrotic remodeling and TGFβ signaling pathway. The effects of Apilimod treatment on myocardial fibrosis, hypertrophy and cardiac function were assessed in a mouse model of pressure overload-induced heart failure. Primary cardiac fibroblasts and HeLa cells treated with Apilimod as well as genetic mutation of PIKfyve in mouse embryonic fibroblasts were used as cell models. When administered , Apilimod reduced myocardial interstitial fibrosis development and prevented left ventricular dysfunction. , Apilimod controlled TGFβ-dependent activation of primary murine cardiac fibroblasts. Mechanistically, both Apilimod and genetic mutation of PIKfyve induced TGFβ receptor blockade in intracellular vesicles, negatively modulating its downstream signaling pathway and ultimately dampening TGFβ response. Altogether, our findings propose a novel function for PIKfyve in the control of myocardial fibrotic remodeling and the TGFβ signaling pathway, therefore opening the way to new therapeutic perspectives to prevent adverse fibrotic remodeling using Apilimod treatment.
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http://dx.doi.org/10.7150/thno.55821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120213PMC
July 2021

Impact of Coronary Artery Disease and Percutaneous Coronary Intervention on Transcatheter Aortic Valve Implantation.

J Interv Cardiol 2021 24;2021:6672400. Epub 2021 Mar 24.

Department of Cardiology, Rangueil University Hospital, Toulouse, France.

Introduction: The prevalence of coronary artery disease (CAD) detected in preoperative work-up for transcatheter aortic valve implantation (TAVI) is high. Instead, the management of a concomitant CAD remains unclear. We evaluate the impact of CAD and percutaneous coronary intervention (PCI) on TAVI procedures.

Materials And Methods: A retrospective study was conducted on 1336 consecutive patients who underwent TAVI in Toulouse University Hospital, Rangueil, France. The studied population was divided into 2 groups: CAD-TAVI group and No CAD-TAVI group. Then, the CAD-TAVI group was segregated into 2 subgroups: PCI-TAVI group and No PCI-TAVI group. In-hospital adverse clinical outcomes were assessed in each group.

Results: Pre-TAVI work-up revealed significant CAD in 36% of 1030 patients eligible for inclusion in the study. The overall prevalence of in-hospital death, stroke, major or life-threatening bleeding, minor bleeding, major vascular complications, minor vascular complications, pacemaker implantation, and acute kidney injury was 2.7%, 2.4%, 2.8%, 3.6%, 3.9%, 7.5%, 12.5%, and 2.7%, respectively. Among the studied population, 55% were admitted to the cardiac care unit. No significant statistical difference was observed between groups. . CAD-TAVI population was not more likely to develop in-hospital adverse clinical outcomes post-TAVI procedure compared to others. Also, no significant difference regarding in-hospital death was observed. In parallel, performing PCI prior to TAVI did not increase the risk of in-hospital death and complications. The difference in terms of the distribution of antithrombotic regimen may explain the higher prevalence of bleeding events in the PCI-TAVI group.

Conclusion: This study provides direct clinical relevance useful in daily practice. No negative impact has been attributed to the presence of a concomitant CAD and/or preoperative PCI on the TAVI hospitalization period.
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http://dx.doi.org/10.1155/2021/6672400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016584PMC
June 2021

Conception and bicentric validation of the proSCANNED score, a simplified bedside prognostic score for Heart Failure patients.

Sci Rep 2021 03 17;11(1):6179. Epub 2021 Mar 17.

Department of Cardiology, Montpellier University Hospital, CHRU Arnaud de Villeneuve, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.

A simple and accurate prognostic tool for Heart Failure (HF) patients is critical to improve follow-up. Different risk scores are accurate but with limited clinical applicability. The current study aims to derive and validate a simple predictive tool for HF prognosis. French outpatients with stable HF of two university hospitals were included in the derivation (N = 134) or in the validation (N = 274) sample and followed up for a median of 23 months. Potential predictors were variables with known association with mortality and easily available. The proSCANNED risk score was derived using a parametric survival model on complete case data; it includes 8 binary variables and its values are 0-8. In the validation sample, the ability of the score to discriminate the 1-year vital status was moderate (AUC = 0.71, IC95% = [0.64-0.71]). However, the stratification of the score in three groups showed a good calibration for patients in the low- and medium-risk risk group. The proSCANNED score is an easy-to-use tool in clinical practice with a good discrimination, stability, and calibration sufficient to improve the medical care of patients. Other follow up studies are necessary to assess score applicability in larger populations, and its impact.
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http://dx.doi.org/10.1038/s41598-021-85767-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969617PMC
March 2021

Selective Cardiomyocyte Oxidative Stress Leads to Bystander Senescence of Cardiac Stromal Cells.

Int J Mol Sci 2021 Feb 24;22(5). Epub 2021 Feb 24.

Institute of Metabolic and Cardiovascular Diseases (I2MC), Inserm UMR 1048, University of Toulouse, 31400 Toulouse, France.

Accumulation of senescent cells in tissues during normal or accelerated aging has been shown to be detrimental and to favor the outcomes of age-related diseases such as heart failure (HF). We have previously shown that oxidative stress dependent on monoamine oxidase A (MAOA) activity in cardiomyocytes promotes mitochondrial damage, the formation of telomere-associated foci, senescence markers, and triggers systolic cardiac dysfunction in a model of transgenic mice overexpressing MAOA in cardiomyocytes (Tg MAOA). However, the impact of cardiomyocyte oxidative stress on the cardiac microenvironment in vivo is still unclear. Our results showed that systolic cardiac dysfunction in Tg MAOA mice was strongly correlated with oxidative stress induced premature senescence of cardiac stromal cells favoring the recruitment of CCR2 monocytes and the installation of cardiac inflammation. Understanding the interplay between oxidative stress induced premature senescence and accelerated cardiac dysfunction will help to define new molecular pathways at the crossroad between cardiac dysfunction and accelerated aging, which could contribute to the increased susceptibility of the elderly to HF.
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http://dx.doi.org/10.3390/ijms22052245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956294PMC
February 2021

Evaluation of Mitral and Aortic Valvular Disease and Left Ventricular Dysfunction in a Lebanese Population: Retrospective Single-Center Experience.

Med Sci Monit 2021 Feb 9;27:e928218. Epub 2021 Feb 9.

Department of Cardiology, Toulouse University Hospital, Toulouse, France.

BACKGROUND Recently, new therapeutic approaches have revolutionized the management of left ventricular dysfunction (LVD) and valvular heart disease (VHD), which are a growing public health problem. In parallel, there are no available epidemiological data about LVD and VHD in developing countries, especially in the Mediterranean area. This retrospective study was conducted at a single center and aimed to evaluate the associations between mitral and aortic valvular disease and left ventricle systolic and diastolic dysfunction in the Lebanese population. MATERIAL AND METHODS A retrospective study was conducted of 4520 consecutive patients aged >18 years who were referred to the Cardiovascular Department of Notre Dame de Secours-University Hospital in Jbeil-Lebanon for transthoracic echocardiography between December 2016 and December 2019. The study population was divided into different groups based on types of LVD and VHD. Left ventricle systolic dysfunction was defined as a left ventricle ejection fraction (EF) ≤40%. Statistical analysis was carried out using SPSS software version 20. RESULTS VHD and systolic dysfunction were more common in men, whereas diastolic dysfunction was more common in women. Being older than age 65 years and smoking were significantly associated with heart failure with preserved EF, whereas female sex was a significant preventive factor against heart failure with reduced EF. Systemic hypertension was correlated with mitral stenosis and tricuspid regurgitation, whereas diabetes mellitus was associated with tricuspid regurgitation (TR). Smoking and older age also appeared to be associated with aortic stenosis. CONCLUSIONS Mitral valve disease (regurgitation and stenosis) was significantly correlated with systolic dysfunction, whereas aortic and mitral regurgitation were associated with diastolic dysfunction. Better monitoring of cardiovascular disease risk factors may lead to a reduced burden of LVD and VHD.
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http://dx.doi.org/10.12659/MSM.928218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883403PMC
February 2021

Non-alcoholic fatty liver disease and heart failure with preserved ejection fraction: from pathophysiology to practical issues.

ESC Heart Fail 2021 04 3;8(2):789-798. Epub 2021 Feb 3.

Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France.

The prevalence of non-alcoholic fatty liver disease (NAFLD) in heart failure (HF) preserved left ventricular ejection fraction (HFpEF) patients could reach 50%. Therefore, NAFLD is considered an emerging risk factor. In 20% of NAFLD patients, the condition progresses to non-alcoholic steatohepatitis (NASH), the aggressive form of NAFLD characterized by the development of fibrosis in the liver, leading to cirrhosis. The purpose of this review is to provide an overview of the relationships between NAFLD and HFpEF and to discuss its impact in clinical setting. Based on international reports published during the past decade, there is growing evidence that NAFLD is associated with an increased incidence of cardiovascular diseases, including impaired cardiac structure and function, arterial hypertension, endothelial dysfunction, and early carotid atherosclerosis. NAFLD and HFpEF share common risk factors, co-morbidities, and cardiac outcomes, in favour of a pathophysiological continuum. Currently, NAFLD and NASH are principally managed with non-specific therapies targeting insulin resistance like sodium-glucose co-transporter-2 inhibitors and liraglutide, which can effectively treat hepatic and cardiac issues. Studies including HFpEF patients are ongoing. Several specific NAFLD-oriented therapies are currently being developed either alone or as combinations. NAFLD diagnosis is based on a chronic elevation of liver enzymes in a context of metabolic syndrome and insulin resistance, with fibrosis scores being available for clinical practice. In conclusion, identifying HF patients at risk of NAFLD is a critically important issue. As soon as NAFLD is confirmed and its severity determined, patients should be proposed a management focused on symptoms and co-morbidities.
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http://dx.doi.org/10.1002/ehf2.13222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006705PMC
April 2021

Early Evaluation of Patients on Axial Flow Pump Support for Refractory Cardiogenic Shock is Associated with Left Ventricular Recovery.

J Clin Med 2020 Dec 21;9(12). Epub 2020 Dec 21.

Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France.

We investigated prognostic factors associated with refractory left ventricle (LV) failure leading to LV assist device (LVAD), heart transplant or death in patients on an axial flow pump support for cardiogenic shock (CS). Sixty-two CS patients with an Impella CP or 5.0 implant were retrospectively enrolled, and clinical, biological, echocardiographic, coronarographic and management data were collected. They were compared according to the 30-day outcome. Patients were mainly male ( = 55, 89%), 58 ± 11 years old and most had no history of heart failure or coronary artery disease (70%). The main etiology of CS was acute coronary syndrome ( = 57, 92%). They presented with severe LV failure (LV ejection fraction (LVEF) 22 ± 9%), organ malperfusion (lactate 3.1 ± 2.1 mmol/L), and frequent use of inotropes, vasopressors, and mechanical ventilation (59, 66 and 30%, respectively). At 24 h, non-recovery was associated with higher total bilirubin (odds ratios (OR) 1.07 (1.00-1.14); = 0.039), lower LVEF (OR 0.89 (0.81-0.96); = 0.006) and the number of administrated amines (OR 4.31 (1.30-14.30); = 0.016). Early evaluation in patients with CS with an axial flow pump implant may enable the identification of factors associated with an unlikely recovery and would call for early screening for LVAD or heart transplant.
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http://dx.doi.org/10.3390/jcm9124130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767477PMC
December 2020

Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis?

Open Heart 2020 10;7(2)

Cardiology, Rangueil University Hospital, Toulouse, France

Background: Cardiac amyloidosis (CA) is a life-threatening restrictive cardiomyopathy. Identifying patients with a poor prognosis is essential to ensure appropriate care. The aim of this study was to compare myocardial work (MW) indices with standard echocardiographic parameters in predicting mortality among patients with CA.

Methods: Clinical, biological and transthoracic echocardiographic parameters were retrospectively compared among 118 patients with CA. Global work index (GWI) was calculated as the area of left ventricular pressure-strain loop. Global work efficiency (GWE) was defined as percentage ratio of constructive work to sum of constructive and wasted works. Sixty-one (52%) patients performed a cardiopulmonary exercise.

Results: GWI, GWE, global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and myocardial contraction fraction (MCF) were correlated with N-terminal prohormone brain natriuretic peptide (R=-0.518, R=-0.383, R=-0.553, R=-0.382 and R=-0.336, respectively; p<0.001). GWI and GLS were correlated with peak oxygen consumption (R=0.359 and R=0.313, respectively; p<0.05). Twenty-eight (24%) patients died during a median follow-up of 11 (4-19) months. The best cut-off values to predict all-cause mortality for GWI, GWE, GLS, LVEF and MCF were 937 mm Hg/%, 89%, 10%, 52% and 15%, respectively. The area under the receiver operator characteristic curve of GWE, GLS, GWI, LVEF and MCF were 0.689, 0.631, 0.626, 0.511 and 0.504, respectively.

Conclusion: In CA population, MW indices are well correlated with known prognosis markers and are better than LVEF and MCF in predicting mortality. However, MW does not perform better than GLS.
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http://dx.doi.org/10.1136/openhrt-2020-001346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555098PMC
October 2020

Dysphagia as an early sign of cardiac decompensation in elderly: case report.

Eur Heart J Case Rep 2020 Aug 17;4(4):1-5. Epub 2020 Jun 17.

Department of Cardiology, Institute CARDIOMET, Rangueil Hospital, Toulouse, France.

Background : Several clinical entities may be misdiagnosed in elderly if we consider dysphagia as a normal aging process in our daily practice. On top of usual aetiologies like motor dysfunction, investigations may uncover serious underlying conditions.

Case Summary : We report an unusual case where dysphagia was the warning sign for acute heart failure in a 76-year-old patient known to have dilated cardiomyopathy with reduced ejection fraction. It was due to an external oesophageal compression by the left atrium. A transthoracic echocardiography, an enhanced thoracic computed tomography-scan and esophagogastroduodenoscopy were used for the diagnosis. Diuretics were the cornerstone treatment with symptomatic improvement.

Discussion : Despite the fact that cardiovascular dysphagia is an uncommon medical entity, but it remains a potential differential diagnosis, especially in elderlies with high risk for atrial enlargement.
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http://dx.doi.org/10.1093/ehjcr/ytaa149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501929PMC
August 2020

Utility of enhanced cardiac magnetic resonance imaging in Kounis syndrome: a case report.

Eur Heart J Case Rep 2020 Aug 9;4(4):1-5. Epub 2020 Jun 9.

Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, University Hospital of Toulouse, Hôpital Rangueil, 1 Avenue Jean Poulhès, 31059 Toulouse, France.

Background: Kounis syndrome is the occurrence of acute coronary syndrome precipitated by an allergic reaction in the presence or absence of underlying coronary artery disease. The syndrome is explained by the effect of released inflammatory mediators on the coronary arteries and platelets.

Case Summary: We report an uncommon case of Kounis syndrome Type II in a 65-year-old man 24 h after being bitten by a hymenoptera. Clinical context, electrocardiogram, coronary angiography, and enhanced cardiac magnetic resonance imaging (MRI) imaging modality are presented.

Discussion: Awareness and understanding of this syndrome is essential for starting early and appropriate therapy, thereby preventing life-threatening events. Accordingly, we highlight the importance of enhanced cardiac MRI to complete the assessment of this entity.
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http://dx.doi.org/10.1093/ehjcr/ytaa118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501905PMC
August 2020

What is the most useful imaging parameter to explore the prognostic value of the right ventricular function at the time of multimodality cardiovascular imaging?

Echocardiography 2020 08 20;37(8):1233-1242. Epub 2020 Jul 20.

Department of Cardiology, University Hospital of Rangueil, Toulouse, France.

Background: Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. The aim of this study was to compare the predictive value of main RV systolic imaging parameters for outcome.

Methods: Seventy-nine patients underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and tomographic equilibrium radionuclide ventriculography (ERV) for the assessment of RV function. The composite primary endpoint (CPE) was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure.

Results: During a mean follow-up of 13 ± 9 months, 15 (19%) patients reached the CPE. The areas under the receiver operator characteristic curves for the prediction of the CPE were 0.922 (P < .001), 0.913 (P < .001), 0.906 (P < .001), 0.849 (P = .002), 0.837 (P = .003), 0.799 (P = .009), 0.792 (P = .011), 0.753 (P = .026), 0.720 (P = .053), and 0.608 (P = .346) for integral systolic S' wave tricuspid annular velocity, RV free wall longitudinal strain (RVFWLS), RV fractional area change, tricuspid annular plane systolic excursion, RV ejection fraction (RVEF) by CMR using the 4-chamber slices, peak systolic S' wave tricuspid annular velocity, RVEF by CMR using short-axis slices, RVEF by ERV, RV myocardial performance index, and RV myocardial acceleration during isovolumic contraction, respectively.

Conclusion: Echocardiographic parameters, and particularly integral systolic S' wave tricuspid annular velocity and RVFWLS, have the best prognostic performance.
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http://dx.doi.org/10.1111/echo.14686DOI Listing
August 2020

Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach.

World J Cardiol 2020 May;12(5):220-227

Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France.

Background: Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle. Patients are usually asymptomatic, and clinical presentation depends on location and adjacent structures impairment. Right ventricle lipomas are scarce in the literature. Moreover, the previous published cases were reported in over 18-year-old patients.

Case Summary: We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up. The diagnosis was confirmed by histopathological examination, and a conservative approach was performed.

Conclusion: Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis. The therapeutic approach depends on clinical presentation.
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http://dx.doi.org/10.4330/wjc.v12.i5.220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284002PMC
May 2020

Coronary Artery Spasm: New Insights.

J Interv Cardiol 2020 14;2020:5894586. Epub 2020 May 14.

Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France.

Coronary artery spasm (CAS) defined by a severe reversible diffuse or focal vasoconstriction is the most common diagnosis among INOCA (ischemia with no obstructive coronary artery disease) patients irrespective to racial, genetic, and geographic variations. However, the prevalence of CAS tends to decrease in correlation with the increasing use of medicines such as calcium channel blockers, angiotensin converting enzyme inhibitor, and statins, the controlling management of atherosclerotic risk factors, and the decreased habitude to perform a functional reactivity test in highly active cardiac catheterization centers. A wide spectrum of clinical manifestations from silent disease to sudden cardiac death was attributed to this complex entity with unclear pathophysiology. Multiple mechanisms such as the autonomic nervous system, endothelial dysfunction, chronic inflammation, oxidative stress, and smooth muscle hypercontractility are involved. Regardless of the limited benefits proffered by the newly emerged cardiac imaging modalities, the provocative test remains the cornerstone diagnostic tool for CAS. It allows to reproduce CAS and to evaluate reactivity to nitrates. Different invasive and noninvasive therapeutic approaches are approved for the management of CAS. Long-acting nondihydropyridine calcium channel blockers are recommended for first line therapy. Invasive strategies such as PCI (percutaneous coronary intervention) and CABG (coronary artery bypass graft) have shown benefits in CAS with significant atherosclerotic lesions. Combination therapies are proposed for refractory cases.
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http://dx.doi.org/10.1155/2020/5894586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245659PMC
November 2020

Identification of a miRNA Based-Signature Associated with Acute Coronary Syndrome: Evidence from the FLORINF Study.

J Clin Med 2020 Jun 1;9(6). Epub 2020 Jun 1.

Institute of Metabolic and Cardiovascular Diseases, INSERM UMR-1048, 31432 Toulouse, France.

Background: The discovery of novel biomarkers that improve risk prediction models of acute coronary syndrome (ACS) is needed to better identify and stratify very high-risk patients. MicroRNAs (miRNAs) are essential non-coding modulators of gene expression. Circulating miRNAs recently emerged as important regulators and fine-tuners of physiological and pathological cardiovascular processes; therefore, specific miRNAs expression profiles may represent new risk biomarkers. The aims of the present study were: i) to assess the changes in circulating miRNAs levels associated with ACS and ii) to evaluate the incremental value of adding circulating miRNAs to a clinical predictive risk model.

Methods And Results: The study population included ACS patients (n = 99) and control subjects (n = 103) at high to very high cardiovascular risk but without known coronary event. Based on a miRNA profiling in a matched derivation case (n = -6) control (n = 6) cohort, 21 miRNAs were selected for validation. Comparing ACS cases versus controls, seven miRNAs were significantly differentially expressed. Multivariate logistic regression analyses demonstrated that among the seven miRNAs tested, five were independently associated with the occurrence of ACS. A receiver operating characteristic curve analysis revealed that the addition of miR-122 + miR-150 + miR-195 + miR-16 to the clinical model provided the best performance with an increased area under the curve (AUC) from 0.882 to 0.924 (95% CI 0.885-0.933, p = 0.003).

Conclusions: Our study identified a powerful signature of circulating miRNAs providing additive value to traditional risk markers for ACS.
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http://dx.doi.org/10.3390/jcm9061674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356017PMC
June 2020

Mid-Ventricular Takotsubo Cardiomyopathy with Hawk's Beak Appearance: A Case Report.

Am J Case Rep 2020 Jan 2;21:e919563. Epub 2020 Jan 2.

Cardiovascular and Metabolic Pole, CHU Toulouse Rangueil, University Paul Sabatier, Toulouse, France.

BACKGROUND Takotsubo cardiomyopathy is a myocardial infarction-like clinical entity commonly occurring after a stressful incident, leading to reversible systolic dysfunction. It involves several subtypes, most often associated with a good prognosis; however, a late diagnosis can contribute to a poor cardiovascular outcome. CASE REPORT We report an unusual case of mid-ventricular takotsubo cardiomyopathy in a 76-year-old woman who presented with recent-onset shortness of breath and compressive chest pain, typically characterized by a hawk's beak shape on left ventriculogram, highlighting the importance of this helpful descriptive but little-known fluoroscopic sign. The final diagnosis was made using transthoracic echocardiography, contrast-enhanced pulmonary angiography, coronary angiography, and left ventriculography. She was successfully treated by beta-blockers and angiotensin-converting enzyme inhibitor, with a good clinical outcome evaluated at 3-month follow-up after hospital discharge. CONCLUSIONS Ventriculography is an important tool for use in making the differential diagnosis in patients presenting with acute coronary syndrome without obstructive coronary artery disease. The hawk's beak shape is an early fluoroscopic diagnostic marker characterizing the mid-ventricular subtype of takotsubo.
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http://dx.doi.org/10.12659/AJCR.919563DOI Listing
January 2020

Short- and Mid-Term Prognosis of Patients Undergoing Rotational Atherectomy in Aortoostial Coronary Lesions in Left Main or Right Coronary Arteries.

J Interv Cardiol 2019 21;2019:9012787. Epub 2019 Aug 21.

Cardiology Department, University Hospital of Toulouse, Toulouse, France.

Objective: To determine short-term and mid-term prognosis in patients with calcified ostial coronary lesions who underwent rotational atherectomy (RA).

Background: RA was developed to facilitate stenting in complex lesions. Treatment of calcified aortoostial coronary lesions with RA appears to have poorer procedure outcomes than nonostial lesions; yet the literature on this topic is scarce.

Methods: Of 498 consecutive patients who underwent RA, a total of 80 (16.1%) presented with aortoostial lesions. A comparative, monocentric study was performed between patients with aortoostial and nonaortoostial stenosis, in a retrospective registry. The primary endpoint was the procedural success rate. Secondary endpoints were the rates of major adverse cardiac and cardiovascular events (MACE) at 30 days and 24 months.

Results: The procedural success rate was high and similar in patients with and without ostial lesions (96.3% 94.7%, p=0.78), as was the rate of angiographic complications (7.5% 8.4%, p=0.80). However, the 30-day mortality rate was significantly higher in the aortoostial group (11.3% 4.8%, p=0.04), as was the 24-month rate of MACE (43.8% 31.8%, p=0.04). The aortoostial location of the lesion was an independent factor associated with the occurrence of cardiovascular events at 24 months (HR = 1.52, 95% CI, 1.03-2.26, p=0.035).

Conclusion: Procedural success and complication rates were similar in patients with and without aortoostial lesions. Despite a poor short- and mid-term prognosis, rotational atherectomy appears to be a feasible and safe treatment option for calcified aortoostial coronary lesions.
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http://dx.doi.org/10.1155/2019/9012787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739796PMC
February 2020

Coronary angiography in the setting of acute infective endocarditis requiring surgical treatment.

Arch Cardiovasc Dis 2020 Jan 13;113(1):50-58. Epub 2019 Nov 13.

Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France. Electronic address:

Background: International guidelines recommend that preoperative coronary angiography is performed on patients at risk of coronary disease who have infective endocarditis requiring surgical treatment. However, the risks of contrast-induced nephropathy or vegetation embolization in case of aortic endocarditis should be considered.

Aims: To assess the safety, therapeutic implications and prognostic impact of coronary angiography in patients requiring surgical treatment for active infective endocarditis.

Methods: This retrospective monocentric study was conducted in patients referred to a tertiary care centre for active endocarditis management with a theoretical indication for surgery between January 2013 and February 2017.

Results: One hundred and ninety-three patients were included; 73.1% were men, the mean age was 61.9±16.3 years and the median EuroSCORE II was 5.8%. One hundred and nineteen patients (61.7%) had aortic endocarditis, which was associated with aortic vegetation in 74 cases (38.3%). Invasive coronary angiography was performed in 142 patients (73.6%) - 130 (91.6%) by radial approach - and 14 patients were evaluated by coronary multislice computed tomography (one patient had exploration with both techniques). Acute renal failure after coronary angiography was observed in 15 patients (10.6%), two patients (1.4%) presented a stroke within 24h after coronary angiography, but none had aortic endocarditis. Among the 178 patients (92.2%) who underwent surgery, 35 (19.7%) had significant coronary lesion(s) and 25 (14.0%) underwent an associated coronary artery bypass graft.

Conclusions: Preoperative coronary angiography in patients affected by infective endocarditis provides relevant information in a significant proportion of patients and can be performed safely.
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http://dx.doi.org/10.1016/j.acvd.2019.09.007DOI Listing
January 2020
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