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Stress-induced abnormalities in myocardial perfusion imaging that are not related to perfusion but are of diagnostic and prognostic importance

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Abstract

Introduction

Certain stress-induced ancillary findings on myocardial perfusion scintigraphy increase the likelihood that the patient has coronary artery disease (CAD); furthermore, among CAD patients, they indicate more severe and extensive disease, placing these patients at higher risk for future cardiac events. Indeed, in studies with no obvious perfusion defect yet with serious CAD—for example, balanced ischemia—it can be these high-risk findings that necessitate invasive intervention.

Discussion

Besides reversible perfusion defects, such findings include increased pulmonary radiotracer uptake, transient cavity dilatation, increased end-diastolic or end-systolic volume, decreased post-stress ejection fraction, and increased right ventricular tracer uptake on stress images. The pathophysiology underlying these findings is clearly different as they do not always occur together, and each independently predicts more severe and extensive CAD. In the current review, these findings are defined and their significance in diagnosing patients with suspected or known CAD is discussed.

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References

  1. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42(7):1318–33.

    Article  PubMed  Google Scholar 

  2. Hansen CL, Cen P, Sanchez B, Robinson R. Comparison of pulmonary uptake with transient cavity dilation after dipyridamole Tl-201 perfusion imaging. J Nucl Cardiol 2002;9(1):47–51.

    Article  PubMed  Google Scholar 

  3. Matoh F, Tawarahara K, Mikami N, Nomura N, Odagiri K, Saito N, et al. Usefulness of lung and right ventricular thallium-201 uptake during single photon emission computed tomography in exercise testing of patients with coronary artery disease. J Cardiol 2005;46(4):131–40.

    PubMed  Google Scholar 

  4. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002;40(8):1531–40.

    Article  PubMed  Google Scholar 

  5. Cosmai EM, Heller GV. The clinical importance of electrocardiographic changes during pharmacologic stress testing with radionuclide myocardial perfusion imaging. J Nucl Cardiol 2005;12(4):466–72.

    Article  PubMed  Google Scholar 

  6. Papaioannou GI, Kasapis C, Seip RL, Grey NJ, Katten D, Wackers FJ, et al. Value of peripheral vascular endothelial function in the detection of relative myocardial ischemia in asymptomatic type 2 diabetic patients who underwent myocardial perfusion imaging. J Nucl Cardiol 2006;13(3):362–8.

    Article  PubMed  Google Scholar 

  7. Min JK, Williams KA, Okwuosa TM, Bell GW, Panutich MS, Ward RP. Prediction of coronary heart disease by erectile dysfunction in men referred for nuclear stress testing. Arch Intern Med 2006;166(2):201–6.

    Article  PubMed  Google Scholar 

  8. Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of lung sestamibi uptake in myocardial perfusion imaging of patients with known or suspected coronary artery disease. J Am Coll Cardiol 2005;45(10):1676–82.

    Article  PubMed  CAS  Google Scholar 

  9. Kaminek M, Myslivecek M, Skvarilova M, Husak V, Koranda P, Metelkova I, et al. Increased prognostic value of combined myocardial perfusion SPECT imaging and the quantification of lung Tl-201 uptake. Clin Nucl Med 2002;27(4):255–60.

    Article  PubMed  Google Scholar 

  10. Morel O, Pezard P, Furber A, Le Jeune JJ, Vielle B, Denizot B, et al. Thallium-201 right lung/heart ratio during exercise in patients with coronary artery disease: relation to thallium-201 myocardial single-photon emission tomography, rest and exercise left ventricular function and coronary angiography. Eur J Nucl Med 1999;26(6):640–6.

    Article  PubMed  CAS  Google Scholar 

  11. Kumar SP, Brewington SD, O’Brien KF, Movahed A. Clinical correlation between increased lung to heart ratio of technetium-99m sestamibi and multivessel coronary artery disease. Int J Cardiol 2005;101(2):219–22.

    Article  PubMed  Google Scholar 

  12. Bacher-Stier C, Sharir T, Kavanagh PB, Lewin HC, Friedman JD, Miranda R, et al. Postexercise lung uptake of 99mTc-sestamibi determined by a new automatic technique: validation and application in detection of severe and extensive coronary artery disease and reduced left ventricular function. J Nucl Med 2000;41(7):1190–7.

    PubMed  CAS  Google Scholar 

  13. Patel GM, Hauser TH, Parker JA, Pinto DS, Sanders GP, Aepfelbacher FC, et al. Quantitative relationship of stress Tc-99m sestamibi lung uptake with resting Tl-201 lung uptake and with indices of left ventricular dysfunction and coronary artery disease. J Nucl Cardiol 2004;11(4):408–13.

    Article  PubMed  Google Scholar 

  14. Georgoulias P, Demakopoulos N, Kontos A, Xaplanteris P, Xydis K, Fezoylidis I. Early post-stress pulmonary uptake of 99mTc tetrofosmin during exercise (SPECT) myocardial perfusion imaging: correlation with haemodynamic, perfusion and function parameters. Nucl Med Commun 2006;27(2):119–26.

    Article  PubMed  Google Scholar 

  15. Martinez EE, Horowitz SF, Castello HJ, Castiglioni ML, Carvalho AC, Almeida DR, et al. Lung and myocardial thallium-201 kinetics in resting patients with congestive heart failure: correlation with pulmonary capillary wedge pressure. Am Heart J 1992;123(2):427–32.

    Article  PubMed  CAS  Google Scholar 

  16. Hurwitz GA. Increased extra-cardiac background uptake on immediate and delayed post-stress images with 99Tcm sestamibi: determinants, independence, and significance of counts in lung, abdomen and myocardium. Nucl Med Commun 2000;21(10):887–95.

    Article  PubMed  CAS  Google Scholar 

  17. Gill JB, Ruddy TD, Newell JB, Finkelstein DM, Strauss HW, Boucher CA. Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 1987;317(24):1486–9.

    Article  PubMed  CAS  Google Scholar 

  18. Brown KA, Boucher CA, Okada RD, Strauss HW, Pohost GM. Quantification of pulmonary thallium-201 activity after upright exercise in normal persons: importance of peak heart rate and propranolol usage in defining normal values. Am J Cardiol 1984;53(11):1678–82.

    Article  PubMed  CAS  Google Scholar 

  19. Nordrehaug JE, Danielsen R, Vik-Mo H. Physiological inverse relationship between heart rate and thallium-201 lung uptake, clearance and lung/myocardial uptake ratio. Eur Heart J 1990;11(7):628–33.

    PubMed  CAS  Google Scholar 

  20. Nishimura T, Uehara T, Hayashida K, Kozuka T. Clinical significance of 201Tl reverse redistribution in patients with aorto-coronary bypass surgery. Eur J Nucl Med 1987;13(3):139–42.

    Article  PubMed  CAS  Google Scholar 

  21. Mahmood S, Buscombe JR, Ell PJ. The use of thallium-201 lung/heart ratios. Eur J Nucl Med 1992;19(9):807–14.

    Article  PubMed  CAS  Google Scholar 

  22. Leslie WD, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic utility of sestamibi lung uptake does not require adjustment for stress-related variables: a retrospective cohort study. BMC Nucl Med 2006;6(1):2.

    Article  PubMed  CAS  Google Scholar 

  23. Jain D, Thompson B, Wackers FJ, Zaret BL. Relevance of increased lung thallium uptake on stress imaging in patients with unstable angina and non-Q wave myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI)-IIIB Study. J Am Coll Cardiol 1997;30(2):421–9.

    Article  PubMed  CAS  Google Scholar 

  24. Choy JB, Leslie WD. Clinical correlates of 99mTc sestamibi lung uptake. J Nucl Cardiol 2001;8(6):639–44.

    Article  PubMed  CAS  Google Scholar 

  25. Cavusoglu Y, Entok E, Timuralp B, Vardareli E, Kudaiberdieva G, Birdane A, et al. Regional distribution and extent of perfusion abnormalities, and the lung to heart uptake ratios during exercise thallium-201 SPECT imaging in patients with cardiac syndrome X. Can J Cardiol 2005;21(1):57–62.

    PubMed  Google Scholar 

  26. Hurwitz GA, Ghali SK, Husni M, Slomka PJ, Mattar AG, Reid RH, et al. Pulmonary uptake of technetium-99m-sestamibi induced by dipyridamole-based stress or exercise. J Nucl Med 1998;39(2):339–45.

    PubMed  CAS  Google Scholar 

  27. Aktas A, Yalcin H, Koyuncu A, Aydinalp A, Muderrisoglu H. The influence of post-exercise cardiac changes on thallium-gated myocardial perfusion scintigraphy findings in normal subjects. Nucl Med Commun 2005;26(2):109–14.

    Article  PubMed  Google Scholar 

  28. Heston TF, Sigg DM. Quantifying transient ischemic dilation using gated SPECT. J Nucl Med 2005;46(12):1990–6.

    PubMed  Google Scholar 

  29. McLaughlin MG, Danias PG. Transient ischemic dilation: a powerful diagnostic and prognostic finding of stress myocardial perfusion imaging. J Nucl Cardiol 2002;9(6):663–7.

    Article  PubMed  Google Scholar 

  30. Bangalore S, Yao SS, Chaudhry FA. Role of angiographic coronary artery collaterals in transient ischemic left ventricular cavity dilatation during stress echocardiography. Clin Cardiol 2006;29(7):305–10.

    PubMed  Google Scholar 

  31. Abidov A, Bax JJ, Hayes SW, Hachamovitch R, Cohen I, Gerlach J, et al. Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT. J Am Coll Cardiol 2003;42(10):1818–25.

    Article  PubMed  Google Scholar 

  32. Van Tosh A, Hecht S, Berger M, Roberti R, Luna E, Horowitz SF. Exercise echocardiographic correlates of transient dilatation of the left ventricular cavity on exercise thallium-201 SPECT imaging. Chest 1994;106(6):1725–9.

    PubMed  Google Scholar 

  33. Slutsky R, Karliner J, Ricci D, Schuler G, Pfisterer M, Peterson K, et al. Response of left ventricular volume to exercise in man assessed by radionuclide equilibrium angiography. Circulation 1979;60(3):565–71.

    PubMed  CAS  Google Scholar 

  34. Stolzenberg J. Dilatation of left ventricular cavity on stress thallium scan as an indicator of ischemic disease. Clin Nucl Med 1980;5(7):289–91.

    Article  PubMed  CAS  Google Scholar 

  35. Weiss AT, Berman DS, Lew AS, Nielsen J, Potkin B, Swan HJ, et al. Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease. J Am Coll Cardiol 1987;9(4):752–9.

    Article  PubMed  CAS  Google Scholar 

  36. Kinoshita N, Sugihara H, Adachi Y, Nakamura T, Azuma A, Kohno Y, et al. Assessment of transient left ventricular dilatation on rest and exercise on Tc-99m tetrofosmin myocardial SPECT. Clin Nucl Med 2002;27(1):34–9.

    Article  PubMed  Google Scholar 

  37. Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson E, Friedman JD, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996;27(7):1612–20.

    Article  PubMed  CAS  Google Scholar 

  38. Toyama T, Caner BE, Tamaki N, Yamamoto K, Nakashima T, Odori T, et al. Transient ischemic dilatation of the left ventricle observed on dipyridamole-stressed thallium-201 scintigraphy. Kaku Igaku 1993;30(6):605–11.

    PubMed  CAS  Google Scholar 

  39. Rivero A, Santana C, Folks RD, Esteves F, Verdes L, Esiashvili S, et al. Attenuation correction reveals gender-related differences in the normal values of transient ischemic dilation index in rest-exercise stress sestamibi myocardial perfusion imaging. J Nucl Cardiol 2006;13(3):338–44.

    Article  PubMed  Google Scholar 

  40. Abidov A, Bax JJ, Hayes SW, Cohen I, Nishina H, Yoda S, et al. Integration of automatically measured transient ischemic dilation ratio into interpretation of adenosine stress myocardial perfusion SPECT for detection of severe and extensive CAD. J Nucl Med 2004;45(12):1999–2007.

    PubMed  CAS  Google Scholar 

  41. McClellan JR, Travin MI, Herman SD, Baron JI, Golub RJ, Gallagher JJ, et al. Prognostic importance of scintigraphic left ventricular cavity dilation during intravenous dipyridamole technetium-99 m sestamibi myocardial tomographic imaging in predicting coronary events. Am J Cardiol 1997;79(5):600–5.

    Article  PubMed  CAS  Google Scholar 

  42. Hung GU, Lee KW, Chen CP, Lin WY, Yang KT. Relationship of transient ischemic dilation in dipyridamole myocardial perfusion imaging and stress-induced changes of functional parameters evaluated by Tl-201 gated SPECT. J Nucl Cardiol 2005;12(3):268–75.

    Article  PubMed  Google Scholar 

  43. Thomas GS, Miyamoto MI, Morello AP, 3rd, Majmundar H, Thomas JJ, Sampson CH, et al. Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The Nuclear Utility in the Community (NUC) Study. J Am Coll Cardiol 2004;43(2):213–23.

    Article  PubMed  Google Scholar 

  44. Heiba SI, Cerqueira MD, Jacobson AF, Ferreira MJ. The value and correlates of left ventricular cavity assessment in dipyridamole 201Tl SPET studies. Nucl Med Commun 1998;19(5):443–9.

    Article  PubMed  CAS  Google Scholar 

  45. Kirkpatrick ID, Leslie WD. Erroneous left ventricular cavity size measurements on myocardial perfusion SPECT resulting from transient arrhythmias. Clin Nucl Med 2005;30(12):783–6.

    Article  PubMed  Google Scholar 

  46. Emmett L, Magee M, Freedman SB, Van der Wall H, Bush V, Trieu J, et al. The role of left ventricular hypertrophy and diabetes in the presence of transient ischemic dilation of the left ventricle on myocardial perfusion SPECT images. J Nucl Med 2005;46(10):1596–601.

    PubMed  Google Scholar 

  47. Fitzgerald J, Danias PG. Effect of motion on cardiac SPECT imaging: recognition and motion correction. J Nucl Cardiol 2001;8(6):701–6.

    Article  PubMed  CAS  Google Scholar 

  48. Chin BB, Moshin J, Bouchard M, Berlin JA, Araujo LI, Alavi A. Hemodynamic indices of myocardial dysfunction correlate with dipyridamole thallium-201 SPECT. J Nucl Med 1996;37(5):723–9.

    PubMed  CAS  Google Scholar 

  49. Druz RS, Akinboboye OA, Grimson R, Nichols KJ, Reichek N. Postischemic stunning after adenosine vasodilator stress. J Nucl Cardiol 2004;11(5):534–41.

    Article  PubMed  Google Scholar 

  50. Sharir T, Germano G, Kavanagh PB, Lai S, Cohen I, Lewin HC, et al. Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation 1999;100(10):1035–42.

    PubMed  CAS  Google Scholar 

  51. Bestetti A, Di Leo C, Alessi A, Triulzi A, Tagliabue L, Tarolo GL. Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning. Nucl Med Commun 2001;22(6):685–93.

    Article  PubMed  CAS  Google Scholar 

  52. Zafrir N, Mats I, Solodky A, Ben-Gal T, Battler A. Characteristics and outcome of octogenarian population referred for myocardial perfusion imaging: comparison with non-octogenarian population with reference to gender. Clin Cardiol 2006;29(3):117–20.

    PubMed  Google Scholar 

  53. Borges-Neto S, Javaid A, Shaw LK, Kong DF, Hanson MW, Pagnanelli RA, et al. Poststress measurements of left ventricular function with gated perfusion SPECT: comparison with resting measurements by using a same-day perfusion-function protocol. Radiology 2000;215(2):529–33.

    PubMed  CAS  Google Scholar 

  54. Senior R, Monaghan M, Becher H, Mayet J, Nihoyannopoulos P. Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography. Heart 2005;91(4):427–36.

    Article  PubMed  CAS  Google Scholar 

  55. Johnson LL, Verdesca SA, Aude WY, Xavier RC, Nott LT, Campanella MW, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. J Am Coll Cardiol 1997;30(7):1641–8.

    Article  PubMed  CAS  Google Scholar 

  56. Emmett L, Iwanochko RM, Freeman MR, Barolet A, Lee DS, Husain M. Reversible regional wall motion abnormalities on exercise technetium-99m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses. J Am Coll Cardiol 2002;39(6):991–8.

    Article  PubMed  Google Scholar 

  57. Ben-Haim S, Gips S, Merdler A, Front A, Tamir A. Myocardial stunning demonstrated with rest and post-stress measurements of left ventricular function using dual-isotope gated myocardial perfusion SPECT. Nucl Med Commun 2004;25(7):657–63.

    Article  PubMed  Google Scholar 

  58. Hashimoto J, Kubo A, Iwasaki R, Iwanaga S, Mitamura H, Ogawa S, et al. Gated single-photon emission tomography imaging protocol to evaluate myocardial stunning after exercise. Eur J Nucl Med 1999;26(12):1541–6.

    Article  PubMed  CAS  Google Scholar 

  59. Smanio PE, Watson DD, Segalla DL, Vinson EL, Smith WH, Beller GA. Value of gating of technetium-99m sestamibi single-photon emission computed tomographic imaging. J Am Coll Cardiol 1997;30(7):1687–92.

    Article  PubMed  CAS  Google Scholar 

  60. Toba M, Kumita S, Cho K, Ibuki C, Kumazaki T, Takano T. Usefulness of gated myocardial perfusion SPECT imaging soon after exercise to identify postexercise stunning in patients with single-vessel coronary artery disease. J Nucl Cardiol 2004;11(6):697–703.

    Article  PubMed  Google Scholar 

  61. Lee DS, Yeo JS, Chung JK, Lee MM, Lee MC. Transient prolonged stunning induced by dipyridamole and shown on 1- and 24-hour poststress 99mTc-MIBI gated SPECT. J Nucl Med 2000;41(1):27–35.

    PubMed  CAS  Google Scholar 

  62. Tanaka H, Chikamori T, Hida S, Usui Y, Harafuji K, Igarashi Y, et al. Comparison of post-exercise and post-vasodilator stress myocardial stunning as assessed by electrocardiogram-gated single-photon emission computed tomography. Circ J 2005;69(11):1338–45.

    Article  PubMed  Google Scholar 

  63. Iwado Y, Furuyama H, Yoshinaga K, Mabuchi M, Ito Y, Noriyasu K, et al. Transient left ventricular dysfunction in ischaemic myocardium after stress: comparative study with exercise and pharmacological stress gated myocardial single photon emission computed tomography. Nucl Med Commun 2003;24(5):551–7.

    Article  PubMed  CAS  Google Scholar 

  64. Williams KA, Schneider CM. Increased stress right ventricular activity on dual isotope perfusion SPECT: a sign of multivessel and/or left main coronary artery disease. J Am Coll Cardiol 1999;34(2):420–7.

    Article  PubMed  CAS  Google Scholar 

  65. Mannting F, Zabrodina YV, Dass C. Significance of increased right ventricular uptake on 99mTc-sestamibi SPECT in patients with coronary artery disease. J Nucl Med 1999;40(6):889–94.

    PubMed  CAS  Google Scholar 

  66. Brown KA, Boucher CA, Okada RD, Strauss HW, McKusick KA, Pohost GM. Serial right ventricle thallium-201 imaging after exercise: relation to anatomy of the right coronary artery. Am J Cardiol 1982;50(6):1217–22.

    Article  PubMed  CAS  Google Scholar 

  67. Nishimura S, Mahmarian JJ, Verani MS. Significance of increased lung thallium uptake during adenosine thallium-201 scintigraphy. J Nucl Med 1992;33(9):1600–7.

    PubMed  CAS  Google Scholar 

  68. Lahiri A, O’Hara MJ, Bowles MJ, Crawley JC, Raftery EB. Influence of left ventricular function and severity of coronary artery disease on exercise-induced pulmonary thallium-201 uptake. Int J Cardiol 1984;5(4):475–90.

    Article  PubMed  CAS  Google Scholar 

  69. Chouraqui P, Rodrigues EA, Berman DS, Maddahi J. Significance of dipyridamole-induced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected coronary artery disease. Am J Cardiol 1990;66(7):689–94.

    Article  PubMed  CAS  Google Scholar 

  70. Duarte PS, Smanio PE, Oliveira CA, Martins LR, Mastrocolla LE, Pereira JC. Clinical significance of transient left ventricular dilation assessed during myocardial Tc-99 m sestamibi scintigraphy. Arq Bras Cardiol 2003;81(5):474–82.

    Article  PubMed  Google Scholar 

  71. Ababneh AA, Sciacca RR, Kim B, Bergmann SR. Normal limits for left ventricular ejection fraction and volumes estimated with gated myocardial perfusion imaging in patients with normal exercise test results: influence of tracer, gender, and acquisition camera. J Nucl Cardiol 2000;7(6):661–8.

    Article  PubMed  CAS  Google Scholar 

  72. Roberti RR, Van Tosh A, Baruchin MA, Gallagher R, Friedman P, Ventura B, et al. Left ventricular cavity-to-myocardial count ratio: a new parameter for detecting resting left ventricular dysfunction directly from tomographic thallium perfusion scintigraphy. J Nucl Med 1993;34(2):193–8.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cardiology Section, Nuclear Medicine, VA Boston Healthcare System and Harvard Medical School, 2C-120, 1400 VFW Parkway, Boston, MA, 02132, USA

    John P. Higgins

  2. Department of Anesthesia, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, 02115, USA

    Johanna A. Higgins

  3. Department of Radiology, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, 02115, USA

    Gethin Williams

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Higgins, J.P., Higgins, J.A. & Williams, G. Stress-induced abnormalities in myocardial perfusion imaging that are not related to perfusion but are of diagnostic and prognostic importance. Eur J Nucl Med Mol Imaging 34, 584–595 (2007). https://doi.org/10.1007/s00259-006-0293-1

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