Saturday 17 May 2014 12:00–13:00 Location: Agora

111 Diagnostic position of Acute Heart Failure (AHF) and relationship to mortalityA report from Euro Heart Failure Survey-1 A Shoaib1 ; A Yasin1 ; R Perveen2 ; K Goode2 ; M Shahid2 ; A Rigby2 ; A Wong1 ; AL Clark1 ; K Swedberg1 1 University of Hull, Department of Academic Cardiology, Hull, United Kingdom; 2 University of Hull, Hull York Medical School, Hull, United Kingdom Introduction: Heart failure (HF) is common in older people and usually associated with other serious medical conditions. Most previous surveys of patients leaving hospital with a diagnosis of HF focused only on those patients with a primary discharge diagnosis, which may reflect only 10-20% of all patients whose hospitalization is complicated by HF. Failure to quantify the true size of the problem may lead to an under-estimate of the health economic impact of HF and under-provision of resources for its care. Methods: Consecutive deaths and discharges during 2000-2001 primarily from medical wards were screened over a 6 week period in 115 hospitals from 24 countries in Europe, to identify patients with known or suspected HF. Information on presenting symptoms and signs was gathered. Mortality was assessed during hospital admission and then 3 months after discharge. Results: Of 10,701 patients enrolled, HF was considered the primary reason for admission in 4,234 (40%) and a secondary reason complicating or prolonging stay in an additional 1,772 (17%). In 4,695 (43%) patients, the investigator was uncertain whether HF contributed to the admission. Patients in the three groups were of similar age (range 72-74 years) and sex (45-47% women) and had similar weight, hematology and biochemistry. Those with a primary diagnosis were more likely to have left ventricular systolic dysfunction (58% v. 51% in those with a secondary and 41% in those with uncertain, diagnosis or) and be treated with loop diuretics prior to admission (71% v. 52% and 58%, respectively). Deaths during the index hospitalization were higher in those with a primary (n = 286; 9%; HR 1.72; P% = < 0.001, CI 1.43-2.08) or secondary diagnosis of HF (n = 278; 16%; HR 3.26; P% = < 0.001, CI 2.7-3.93) compared to an uncertain diagnosis. Mortality in the 12 weeks after discharge was also highest in those with a secondary diagnosis of HF (n = 389; 22%) compared to those with primary (n = 558; 13%) or uncertain (n = 412; 9%) diagnoses. Conclusion: HF as a secondary diagnosis carries a high mortality. Suspected but unconfirmed HF is not benign and probably reflects a mixture of patients with a heterogeneous prognosis, including those with inadequately investigated HF, patients with other serious medical problems and patients receiving inappropriate loop diuretic treatment.

112 Differences in clinical impact of blood urea nigtrogen on cardiac death in ischemic and non-ischemic acute heart failure : a report from the ATTEND registry N Sato1 ; K Kajimoto2 ; T Takano3 Nippon Medical School Musashi-Kosugi Hospital, Cardiology and Intensive Care Unit, Kanagawa, Japan; 2 Sensoji Hospital, Tokyo, Japan; 3 Nippon Medical School, Tokyo, Japan


Background/Aim: It is well known that serum blood urine nitrogen (BUN) is one of the important prognostic markers of acute heart failure (AHF). However, it is not clarified well whether or not BUN is a good predictor for cardiac death as well as all-cause death during hospitalization and also whether or not there are any differences in clinical impact on outcome in etiologies of AHF. Therefore, to clarify the aim, we analyzed using the data from the acute decompensated heart failure syndromes (ATTEND) registry, which is the largest AHF registry in Japan. Methods: The ATTEND registry is a nationwide, multicenter, prospective cohort study. In the present study, the data from 4820 AHF patients were analyzed. The

cut-off value of BUN was analyzed using receiver operating characteristic curve analysis regarding in-hospital mortality. Using the cut-off value of BUN, patient characteristics were compared between, higher BUN and lower BUN groups. To clarify the heterogeneity of the prognostic value of BUN at admission with respect to all-cause and cardiac death, subgroup analysis was performed by a logistic regression model. Results: The cut-off value of BUN at admission was 27 mg/dl regarding in-hospital mortality (AUC 0.71). Compared to those with lower BUN patients, the higher BUN (>27) patients were higher age, lower systolic blood pressure, and had higher proportion of ischemic etiology. Odds ratios of all-cause and cardiac death were 4.05 and 4.57, respectively, suggesting BUN was a good predictor for cardiac death as well as all-cause death. Furthermore, in non-ischemic etiologies, i.e., dilated cardiomyopathy and valvular diseases, the odds ratio regarding cardiac death was significantly higher ( 6.66 [4.57-9.71], P < 0.001) than that of ischemic (2.24 [1.38-3.63]). Conclusion: Thus, the present study demonstrated that BUN was the important and valuable prognostic marker in cardiac death as well as all-cause death and especially in non-ischemic AHF patients.

113 The long-term prognosis in acute heart failure population based on easy available new clinical score K Bury1 ; J Zalewski1 ; A Furman1 ; G Opolski2 ; L Polonski3 ; R Szelemej4 ; E Straburzynska-Migaj5 ; J Niedziela3 ; J Drozdz6 ; J Nessler1 1 Institute of Cardiology, Jagiellonian University, John Paul II Hopsital, Depart. of Coronary Disease, Krakow, Poland; 2 1st Department of Cardiology, Warsaw Medical University, Warsaw, Poland; 3 Silesian Center for Heart Diseases, Zabrze, Poland; 4 Department of Cardiology, Walbrzych, Poland; 5 Department of Cardiology, Medical University of Poznan, Poznan, Poland; 6 Medical University of Lodz, Department of Cardiology, Lodz, Poland Purpose: We sought to investigate whether easy available, clinical parameters may be useful to predict long-term prognosis in patients (pts) hospitalized due to acute heart failure (HF). Methods: We evaluated long-term clinical outcomes of 499 pts with acute HF enrolled in the Heart Failure Pilot Survey in Poland. The residual symptoms of HF at discharge after enrollment included pulmonary rales, peripheral oedema or hypoperfusion, jugular vein pressure, S3 gallop, pleural effusion and confusion. The ratio of systolic blood pressure and heart rate (SBP/HR) at discharge was calculated. Results: During baseline hospitalization 55 (11%) pts required inotropic support. At discharge, 319 (64%) pts were without any clinical symptoms of HF, 110 (22%) had 1 or 2 symptoms and the rest of 70 (14%) pts presented more than 2 symptoms of HF. During 12-month follow-up 86 (17%) pts died. Multiple regression analysis showed that patient’s age (OR = 1.05 per year, 95%CI 1.02-1.07, P < 0.0001), history of myocardial infarction or angina (2.07, 1.17-3.69, P = 0.0004), inotropic support on admission (4.56, 2.33-8.90, P < 0.0001), residual symptoms of HF (1.83 per symptom, 1.38-2.44, P < 0.0001) and SBP/HR ratio (0.2 per 1.0, 0.09-0.49, P = 0.0004) were independent predictors of death. Based on the results of multiple analysis age ≥ 70 was scored as 1, history of myocardial infarction or angina as 1, inotropic support on admission as 1, one or two residual HF symptoms at discharge as 1, more than two symptoms as 2, SBP/HR ratio of 1.2-1.8 as 1 and of < 1.2 as 2. The prognostic value of the new score in shown on figure. Conclusions: The new score derived from easy available clinical parameters may be useful in prediction of long-term mortality in acute HF patients. It requires further validation in a large cohort of HF patients.

© 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365




114 Ventricular conduction abnormalities as predictors of long-term survival in acute de-novo and decompensated chronic heart failure HEV Tolppanen1 ; K Siirila-Waris2 ; V-P Harjola3 ; D Marono4 ; P Kreutzinger4 ; T Nieminen1 ; T Tarvasmaki2 ; R Twerenbold4 ; C Mueller4 ; J Lassus1 1 Helsinki University Central Hospital, Heart and lung center, Division of Cardiology, Helsinki, Finland; 2 University Hospital Basel, Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland Purpose: The role of ventricular conduction abnormalities in the survival of patients with acute heart failure (AHF) is still controversial. Our aim was to find prognostic factors in the admission electrocardiogram (ECG) in AHF, and compare them between patients with de-novo AHF and acutely decompensated chronic heart failure (ADCHF). Methods: We analysed the admission ECG of 982 patients from a European multicentre prospective cohort of AHF. The mean follow-up was 3.9 years and the end-point was all-cause mortality. In the multivariate models Cox proportional hazard ratios (HR) were adjusted for age, sex, clinically relevant comorbidities, renal function, smoking, and NT-proBNP. Results: Patients with de-novo AHF (n = 506) were younger and had less cardiac morbidities than those with ADCHF (n = 476). In total, ventricular conduction abnormalities were more common in ADCHF than in de-novo AHF [IVCD (QRS width ≥ 110 ms, no bundle branch block) 20.6% vs. 13.2%, P = 0.001; LBBB 17.2% vs. 8.7%, P < 0.001; and RBBB 6.9% vs. 8.1%, P% = NS; respectively]. Mortality during the follow-up was higher in patients with RBBB (85.4%) and IVCD (73.7%) compared to those with normal ventricular conduction (57.0%); P < 0.001 for both. Figure 1 shows the unadjusted HRs for each conduction abnormality in the overall AHF population. The impact of RBBB on survival was driven by de-novo AHF [adjusted HR 1.93 (1.03-3.60); P = 0.04], whereas IVCD was an independent predictor of death in ADCHF [adjusted HR 1.79 (1.28-2.52); P = 0.001]. LBBB was not associated with increased mortality in either of the subgroups. Conclusion: Ventricular conduction abnormalities are more frequent in ADCHF compared to de-novo AHF. RBBB predicts poor long-term survival in patients with de-novo AHF, and IVCD in those with ADCHF.

Background: Insulin resistance (IR) is a common finding in chronic heart failure (CHF). Nevertheless there is a lack of data about its link with endothelium-dependent vasodilatory response and peripheral blood flow in systolic CHF. Objective: To study flow-mediated vasodilation (FMD) and peripheral blood flow in relation to IR in systolic CHF patients (pts). Methods: 51 stable NYHA II-IV CHF pts (46 males, median age 60 years, 39 – ischemic, 12 – non-ischemic) with left ventricular ejection fraction (LVEF) 2.7. By triplex-mode scanning peak systolic (Vps) and end-diastolic (Ved) blood flow velocities, peripheral resistance index (RI as the ratio Vps-Ved to Ved) was calculated in the posterior tibial artery; assessment of FMD of the brachial artery was carried out by the standard cuff test. Results: IR was found in 25 pts (49%). In IR pts FMD (M = 5.87; SD = 2.70) was significantly lower (p = 0.031) than in pts without IR (M = 8.49; SD = 5.31). IR group demonstrated significantly (p = 0.001) higher RI (M = 0.89; SD = 0.03) in comparison to non-IR group (M = 0.85; SD = 0.04). Respectively, significant correlation relationship were found between HOMA index and FMD (rho% = -0.360; p = 0.009), and between HOMA index and RI (rho = 0.395; p = 0.004). There were no significant differences between IR and non-IR groups for systolic blood pressure (SBP) (p = 0.765), heart rate (HR) (p = 0.790), LVEF (p = 0.123). Conclusion: In systolic CHF, despite no difference in hemodynamic variables (SBP, HR, LVEF), IR pts demonstrate lower FMD response in the brachial artery and higher resistance index in the posterior tibial artery compared with non-IR group.

116 Prognostic values of consecutive left ventricular ejection fraction: implications from systolic heart failure cohort YC Hsiao1 ; CR Jian1 ; TH Chen2 Gung University College of Medicine, Tao-Yuan, Taiwan; 2 Taoyuan Chang Gung Memorial Hospital, Cardiology, Tao-yuan, Taiwan

1 Chang

Purpose: Many systolic heart failure researches demonstrated repeated, illogical results that renal function is critical to predict mortality in patients with reduced ejection fraction but values of ejection fraction isn’t. We designed prospective cohort study to exam the correlation between values of ejection fraction and mortality. Methods: This is a prospective cohort study enrolled patients with left ventricular ejection fraction (LVEF) below 35%. Subjects were divided into three groups according to difference of consecutive ejection fraction ( < 0%, 0–≤10%, and >10%) 6 months after enrollment. Primary end point is mortality or heart failure re-admission. Results: The study enrolled 818 patients from January 1st to December 31th in 2010. The proportion of three LVEF groups were 37.2% (improved LVEF group), 32.6% (unchanged LVEF group) and 30.1% (worsening LVEF group). The different values between baseline LVEF and second LVEF were -6.5%, 5.1% and 22.1%, respectively. The incidence rate (per 100 person-years) for all-cause mortality were 4.6, 7.9, and 8.5. Multivariable analysis revealed that age, second LVEF, eGFR, use of warfarin, aspirin, and diuretic were associated with mortality but baseline LVEF was not. For the 3-year-all-cause mortality, the adjusted hazard ratios was 2.52 (95% confidence interval 1.37-4.64, p = 0.003) for patients with unchanged LVEF, compared with dominantly improved LVEF group, and 0.962 (95% confidence interval 0.946-0.979, p < 0.001) for second LVEF 6 months after enrollment. Conclusions: In patients with systolic failure, initial LVEF is no relevant to predict mortality but followed LVEF or improved LVEF is critical to better survival. Clinical characteristics with mortality Variable

Unadjusted hazard ratios for mortality

HR (95% CI)


baseline eGFR



baseline LVEF,%



second LVEF,%


< 0.001











Insulin resistance, flow-dependent vasodilation and peripheral blood flow in chronic systolic heart failure

LVEF unchanged v.s. improved



WRF v.s. None WRF



L Voronkov; M Ilnytska; T Gavrilenko; I Shkurat NSC Institute of Cardiology M.D. Strazhesko, Heart Failure, Kiev, Ukraine

eGFR% = estimated glomerular filtration rate WRF% = woesening renal function

© 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365



117 Pharmacological treatment of severe hypertensive acute heart failure: effectiveness of iv isosorbide dinitrate single versus isosorbide dinitrate plus furosemide S Jouini; R Hamed; S Souissi; H Ghazali; F Amira; A Yahmadi; B Bouhajja Charles Nicolle Hospital, Emergency department, Tunis, Tunisia Introduction: Hypertensive acute heart failure (AHF) is accompanied by a redistribution of blood volume to the pulmonary circulation in favor of hypertension crisis where volemia is normal or reduced. The use of diuretics in this context is controversial (1). The objective of this clinical trial was to study the effectiveness of high dose nitrate therapy isosorbide dinitrate (ISDN) with IV furosemide versus ISDN alone, in the treatment of severe hypertensive AHF admitted in emergency department. Materials and Methods: We conducted a single- center, prospective, randomized, double blind and placebo-controlled clinical trial. Inclusion of severe hypertensive AHF over 6 months. Standardization of: i) the antihypertensive treatment with continuous IV ISDN at doses suitable for systolic BP; ii) the oxygen protocol (CPAP or facial mask); iii) criteria of sevrage of the O2 therapy and emergency exit. Thereafter patients were randomly allocated to receive: 1) ISDN + IV furosemide 40 mg (ISDN+F), and 2) ISDN + placebo (10 ml NaCl IV) (ISDN+P). Outcome measures: Duration of O2 therapy before reaching the goal of a SpO2 > 95% on room air, length of stay in emergency department and frequency of early recurrences ( < 7 days). Results: We enrolled 74 consecutive patients with severe hypertensive AHF. Mean age = 69, 4 + / - 9 years, sex ratio = 0.60. Comparison of baseline characteristics and outcome measures (table). Conclusion: High dose ISDN associated with furosemide does not shorten the duration of O2 therapy or length of stay in emergency department compared to high dose ISDN alone in the treatment of severe hypertensive AHF. Early recurrences are more frequent in ISDN + F. Baseline characteristics and outcome Group (ISDN + F) N = 35

Group (ISDN + P) N = 39

Age (years)

70+/- 8


Systolic arterial blood pressure(mm Hg)

197 +/- 26

206+/- 31 83+/- 7

Oxygen saturation (%) ∘

84 +/- 6

ISDN dose (mg)*

31,5+/- 17

39,8+/- 28

Duration of O2 therapy (hours)

8,16 +/- 5

7,4 +/- 3,5

Length of stay in ED (hours)

16+/- 13

14+/- 5

Early recurrences ( < 7 days) (n)



∘ : At admission on room air. *: total dose ISDN% = isosorbide dinitrate. ED% = emergency department F% = furosemide. P% = placebo

118 Novel wearable vest for tracking pulmonary congestion in acutely decompensated heart failure: pilot study P Gastelurrutia Germans Trias i Pujol Health Sciences Research Institute, Badalona, Spain Purpose: To evaluate a portable wearable bioimpedance vest to track recompensation of acutely decompensated heart failure (ADHF). Pulmonary congestion, a landmark sign of ADHF, may be objectively monitored with transthoracic textile bioimpedance sensors. Methods: Patients admitted to the cardiology ward with ADHF were screened for inclusion. The four Cole parameters were fitted to the measured bioimpedance spectra: R0 reflects extracellular fluids, R∞ intracellular fluids, fc is tissue relaxation time, and 𝛼 is tissue heterogeneity. Bioimpedance measurements and heart rate by the investigational device, body weight, New York Heart Association class, and a clinical severity score were registered on admission, on the three subsequent days, and at discharge. Results: Twenty patients were recruited (15% female, mean age 74.7 ± 9.5 years, left ventricular ejection fraction 37.0 ± 12.5%). Bioimpedance improvement was detected in 90% of patients, and relative changes in bioimpedance during hospital admission properly tracked fluid loss as measured by weight (p < 0.001) and clinical severity score (p < 0.001). Significant correlations were also found between bioimpedance and other routine parameters of HF severity, such as left ventricular

ejection fraction (r = 0.450, p = 0.047) and NT-proBNP levels (r% = −0.41, p = 0.038). Clinical severity was predicted by combining bioimpedance (estimation of a dry lung), heart rate, and R∞ in a naïve Bayesian model with AUC = 0.76, as estimated by leave-patient-out cross validation. Conclusions: Serial monitoring of the transthoracic bioimpedance spectrum assessed by textile sensors tracked ADHF recompensation during hospital admission. Future studies will confirm whether clinical decision making in ADHF might benefit from this noninvasive, easy-to-use bioimpedance vest.


119 Invasive vs. non-invasive ventilation and ventilatory parameters: do they predict outcome in cardiogenic shock M Hongisto1 ; J Lassus2 ; T Tarvasmaki3 ; H Tolppanen2 ; J Tolonen3 ; J Masip4 ; V-P Harjola1 1 Helsinki University Central Hospital, Division of emergency care, Department of medicine, Helsinki, Finland; 2 University of Barcelona, Hospital Sant Joan Despí Moisés Broggi, Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain Purpose: Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over non-invasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We analysed the role of ventilation strategies (VS) for in-hospital (I-H) outcome in CS. Methods: 220 patients from the European CardShock study were categorized by maximal ventilatory support needed during the first 24 hours into MV and NIV groups. Clinical characteristics, treatment and outcome were analysed. Results: Mean age was 66.6 years (SD 11.8), 73% were men. MV 134 (61%) and NIV 28 (13%) groups did not differ significantly in age, gender, medical history, etiology of CS, PaO2/FiO2-ratio, baseline hemodynamics or LVEF. ACS was the main cause of CS (81% in MV and 79% in NIV group). 3 (2%) of MV group was initially treated with NIV. After the first 24 hours 5 (18%) from NIV group got intubated. Differences in laboratory and ventilatory parameters, length of hospital stay (LOS) and I-H mortality are shown in the table. MV group had significantly higher lactate level and greater need for vasoactive drugs referring to severe tissue hypoperfusion whereas NIV group seemed to be more congestive. After adjusting for other predictors of outcome (age, history of CABG, systolic blood pressure, LVEF, lactate, ACS and need for adrenalin), mean 0-24 h FiO2 (OR 1.04; 95% CI 1.01-1.07; P = 0.013) was independently associated with I-H mortality. However, VS had no influence on prognosis (OR 0.41; 95% CI 0.08-2.10; P = 0.28). Conclusions: Though MV is generally recommended, a fair number of patients were treated with NIV. Moreover, initial VS did not affect outcome. Thus NIV seems a safe option for properly chosen CS patients. Interestingly, of the ventilatory parameters, only mean 24-hour FiO2 independently predicted I-H mortality.




TroponinT 0 h, ng/l *

5081 (9981)

7892 (10414)


NT-proBNP 0 h, pg/ml *

7727 (12571)

11115 (14735)


lactate 0 h, mmol/l *

4.9 (3.9)

2.9 (3.3)

< 0.001

mean FiO2 0-24 h, % *

63 (19)

54 (19)


mean PaO2 0-24 h , kPa *

14.6 (4.1)

12 (1.8)


LOS, day *

21 (16)

17 (12)


I-H mortality, n(%)

61 (46)

6 (21)


*% = mean (SD)

© 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365



120 Low galectin 3 identifies a heart failure population at minimal risk of 30 day rehospitalization and death WF Peacock1 ; RA Deboer2 ; AS Maisel3 Baylor College of Medicine, Houston, United States of America; 2 University of Groningen, Groningen, Netherlands; 3 Veterans Affairs San Diego Health Care System, San Diego, United States of America


Purpose: For patients hospitalized with heart failure (HF), the 30 day readmission rate may exceed 20%. It would be potentially useful to prospectively identify patients at low risk for mortality or re-hospitalization as this population could represent a cohort potentially eligible for early discharge without concern for revisits. Our purpose was, using the PRIDE dataset, to determine if a Galectin 3 cutpoint could be determined that identified patients at low risk for 30 day death or rehospitalizatoin. Methods: The N-Terminal Pro-BNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study enrolled 599 patients presenting to the emergency department with acute dyspnea. Using a subset of this study we evaluated the relationship between galectin 3 levels and the outcomes of rehospitalization and mortality.

Results: Of the originally enrolled PRIDE patients, 181 (36% of the original cohort) had AHF and sufficient banked serum for galectin 3 measurement. Of the AHF cohort, the median (IQR) age was 76 (66, 83), 84 (46.4%) were female, 164 (90.1%) were Caucasian. The median (IQR) BNP was 386 (174, 827) pg/mL and ejection fraction was 51% (32, 64); 63 (34.8%) had an EF < 40%. Overall, the median (IQR) galectin 3 level was 14.9 (11.0, 19.9), with a maximum of 58.4 ng/mL. DEATH: Of 11 (6.1%) patients who died within 30 days, their median (IQR) galectin 3 was 18 ng/mL (21.5, 32.6). No patient died with a galectin 3 < 11.5 ng/mL. By 90 days, 21 (11.6%) had died, with a median (IQR) galectin 3 of 18.9 ng/mL (14.9, 29.9); 1 (4.8%) patient died with a galectin 3 of 5.9 ng/mL at day 47, otherwise no patient died with a galectin 3 < 11.5 during the 90 day follow up period. REHOSPITALIZATION: Of 12 patients (6.6%) re-hospitalized within 30 days, and 23 (12.7%) within 90 days, their median (IQR) galectin 3 was 19.6 ng/mL (15.8, 21.5) and 20.7 ng/mL (13.0, 26.4), respectively. Except for 1 individual with a galectin 3 of 5.1 ng/mL, no patient was re-hospitalized within 30 days if the galectin 3 was < 11.7 ng/mL. Except for 3 (13%) patients, no patient was rehospitalized within 90 days with a galectin 3 < 11.1 ng/mL. A galectin 3 < 11.5 occurred in 51 (28%) patients. Conclusion: A galectin 3 < 11.5 ng/mL, occurring in nearly 1/3 of patients, identifies a population with zero thirty day mortality, and a very low ( < 5%) re-hospitalization rate.

© 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365

Abstracts of the Heart Failure Congress 2014 and the 1st World Congress on Acute Heart Failure, May 17–20, 2014, Athens, Greece.

Abstracts of the Heart Failure Congress 2014 and the 1st World Congress on Acute Heart Failure, May 17–20, 2014, Athens, Greece. - PDF Download Free
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