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The prognostic significance of atrial fibrillation in heart failure with preserved ejection function: insights from KaRen, a prospective and multicenter study

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Abstract

The prognostic value of atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFPEF) remains controversial. We sought to study the prognostic value of AF in a prospective cohort and to characterize the HFPEF patients with AF. KaRen was a prospective, multicenter, international, observational study intended to characterize HFPEF; 538 patients presenting with an acute decompensated cardiac failure and a left ventricular EF > 45% were included. EKG and echocardiogram performed 4–8 week following the index hospitalization were analyzed in core centers. Clinical and echocardiographic characteristics of patients in sinus rhythm vs. with documented AF at enrolment (decompensated HF), upon their 4–8-week visit (in presumed stable clinical condition) and according to patients’ cardiac history, were compared. The primary study endpoint was death from any cause or first hospitalization for decompensated heart failure (HF). A total of 413 patients (32% in AF) were analyzed, with a mean follow-up period of 28 months. The patients were primarily elderly individuals (mean age: 76.2 years), with a slight female predominance and a high prevalence of non-cardiovascular comorbidities. The baseline echocardiographic characteristics and the natriuretic peptide levels were indicative of a more severe heart condition among the patients with AF. However, the patients with AF exhibited a similar survival-free interval compared with the patients in sinus rhythm. In this elderly HFPEF population with a high prevalence of non-cardiovascular comorbidities, the presence of AF was not associated with a worse prognosis despite impaired clinical and echocardiographic features.

ClinicalTrials.gov: NCT00774709.

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References

  1. Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D (1998) Impact of atrial fibrillation on the risk of death—the Framingham heart study. Circulation 98:946–952

    Article  CAS  PubMed  Google Scholar 

  2. Pedersen OD, Bagger H, Kober L, Torp-Pedersen C (1999) The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution. Eur Heart J 20(10):748–754

    Article  CAS  PubMed  Google Scholar 

  3. Nilsson KR Jr, Al-Khatib SM, Zhou Y, Pieper K, White HD, Maggioni AP, Kober L, Granger CB, Lewis EF, McMurray JJ, Califf RM, Velazquez EJ (2010) Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial. Heart 96(11):838–842

    Article  PubMed  Google Scholar 

  4. Olsson LG, Swedberg K, Ducharme A, Granger CB, Michelson EL, McMurray JJ, Puu M, Yusuf S, Pfeffer MA, Investigators CHARM (2006) Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program. J Am College Cardiol 47(10):1997–2004

    Article  Google Scholar 

  5. Swedberg K, Olsson LG, Charlesworth A, Cleland J, Hanrath P, Komajda M, Metra M, Torp-Pedersen C, Poole-Wilson P (2005) Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J 26(13):1303–1308

    Article  CAS  PubMed  Google Scholar 

  6. Mulder BA, van Veldhuisen DJ, Crijns HJ, Bohm M, Cohen-Solal A, Babalis D, Roughton M, Flather MD, Coats AJ, Van Gelder IC (2012) Effect of nebivolol on outcome in elderly patients with heart failure and atrial fibrillation: insights from SENIORS. Eur J Heart Fail 14(10):1171–1178

    Article  CAS  PubMed  Google Scholar 

  7. Vermes E, Tardif JC, Bourassa MG, Racine N, Levesque S, White M, Guerra PG, Ducharme A (2003) Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials. Circulation 107(23):2926–2931

    Article  PubMed  Google Scholar 

  8. Lund LH, Donal E, Oger E, Hage C, Persson H, Haugen-Lofman I, Ennezat PV, Sportouch-Dukhan C, Drouet E, Daubert JC, Linde C; KaRen Investigators (2014) Association between cardiovascular vs. non-cardiovascular co-morbidities and outcomes in heart failure with preserved ejection fraction. Eur J Heart Fail 16(9):992–1001

  9. Donal E, Lund LH, Linde C, Edner M, Lafitte S, Persson H, Bauer F, Ohrvik J, Ennezat PV, Hage C, Löfman I, Juilliere Y, Logeart D, Derumeaux G, Gueret P (2009) Rationale and design of the Karolinska–Rennes (KaRen) prospective study of dyssynchrony in heart failure with preserved ejection fraction. Eur J Heart Fail 11(2):198–204

    Article  PubMed  PubMed Central  Google Scholar 

  10. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N England J Med 285(26):1441–1446

    Article  CAS  Google Scholar 

  11. Donal E, Lip GY, Galderisi M, Goette A, Shah D, Marwan M, Lederlin M, Mondillo S, Edvardsen T, Sitges M, Grapsa J, Garbi M, Senior R, Gimelli A, Potpara TS, Van Gelder IC, Gorenek B, Mabo P, Lancellotti P, Kuck KH, Popescu BA, Hindricks G, Habib G, Cardim NM, Cosyns B, Delgado V, Haugaa KH, Muraru D, Nieman K, Boriani G, Cohen A (2016) EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 17(4):355–383

    Article  PubMed  Google Scholar 

  12. Mahoney P, Kimmel S, DeNofrio D, Wahl P, Loh E (1999) Prognostic significance of atrial fibrillation in patients at a tertiary medical center referred for heart transplantation because of severe heart failure. Am J Cardiol 83(11):1544–1547

    Article  CAS  PubMed  Google Scholar 

  13. Grigorian Shamagian L, Roman AV, Seara JG, Sande JL, Veloso PR, Gonzalez-Juanatey JR (2006) Atrial fibrillation in patients hospitalized for congestive heart failure: The same prognostic influence independently of left ventricular systolic function? Int J Cardiol 110:366–372

    Article  PubMed  Google Scholar 

  14. Singh SN, Poole J, Anderson J, Hellkamp AS, Karasik P, Mark DB, Lee KL, Bardy GH; SCD-HeFT Investigators (2006) Role of amiodarone or implantable cardioverter/defibrillator in patients with atrial fibrillation and heart failure. Am Heart J 152(5):974.e7–974e11

  15. Swedberg K, Olsson LG, Charlesworth A, Cleland J, Hanrath P, Komajda M, Metra M, Torp-Pedersen C, Poole-Wilson P (2005) Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J 26(13):1303–1308

    Article  CAS  PubMed  Google Scholar 

  16. Pai RG, Varadarajan P (2007) Prognostic significance of atrial fibrillation is a function of left ventricular ejection fraction. Clin Cardiol 30(7):349–354

    Article  PubMed  Google Scholar 

  17. Parkash R, Maisel WH, Toca FM, Stevenson G (2005) Atrial fibrillation in heart failure: high mortality risk even if ventricular function is preserved. Am Heart J 150(4):701–706

    Article  PubMed  Google Scholar 

  18. Fung JW, Sanderson JE, Yip GW, Zhang Q, Yu CM (2007) Impact of atrial fibrillation in heartfailure with normal ejection fraction: clinical and echocardiographic study. J Card Fail 13(8):649–655

    Article  PubMed  Google Scholar 

  19. Zakeri R, Chamberlain AM, Roger VL, Redfield MM (2013) Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study. Circulation 128(10):1085–1093

    Article  PubMed  PubMed Central  Google Scholar 

  20. Eapen ZJ, Greiner MA, Fonarow GC, Yuan Z, Mills RM, Hernandez AF, Curtis LH (2014) Associations between atrial fibrillation and early outcomes of patients with heart failure and reduced or preserved ejection fraction. Am Heart J 167(3):369–375 e2

  21. Rusinaru D, Leborgne L, Peltier M, Tribouilloy C (2008) Effect of atrial fibrillation on long-term survival in patients hospitalised for heart failure with preserved ejection fraction. Eur J Heart Fail 10(6):566–572

    Article  PubMed  Google Scholar 

  22. Hamaguchi S, Yokoshiki H, Kinugawa S, Tsuchihashi-Makaya M, Yokota T, Takeshita A, Tsutsui H, Registry Japanese Cardiac, Of Heart Failure in Cardiology (2009) Effects of atrial fibrillation on long-term outcomes in patients hospitalized for heart failure in Japan: a report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 73(11):2084–2090

    Article  CAS  PubMed  Google Scholar 

  23. Linssen GC, Rienstra M, Jaarsma T, Voors AA, van Gelder IC, Hillege HL, van Veldhuisen DJ (2011) Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 13(10):1111–1120

    Article  PubMed  Google Scholar 

  24. McManus DD, Hsu G, Sung SH, Saczynski JS, Smith DH, Magid DJ, Gurwitz JH, Goldberg RJ, Go AS; Cardiovascular Research Network PRESERVE Study (2013) Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction. J Am Heart Assoc 2(1):e005694

    Google Scholar 

  25. Cheng M, Lu X, Huang J, Zhang J, Zhang S, Gu D (2014) The prognostic significance of atrial fibrillation in heart failure with a preserved and reduced left ventricular function: insights from a meta-analysis. Eur J Heart Fail 16(12):1317–1322

    Article  PubMed  Google Scholar 

  26. Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, Wehrens XH, Deswal A (2012) Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll of Cardiol 59(11):998–1005

    Article  Google Scholar 

  27. Maréchaux S, Six-Carpentier MM, Bouabdallaoui N, Montaigne D, Bauchart JJ, Mouquet F, Auffray JL, Le Tourneau T, Asseman P, LeJemtel TH, Ennezat PV (2011) Heart Vessels 26:313

    Article  PubMed  Google Scholar 

  28. Wasywich CA, Whalley GA, Gamble GD, Wright SP, Doughty RN (2006) Does rhythm matter? The prognostic importance of atrial fibrillation in heart failure. Heart Lung Circ 15(6):353–357

    Article  PubMed  Google Scholar 

  29. Setoguchi M, Hashimoto Y, Sasaoka T, Ashikaga T, Isobe M (2015) Risk factors for rehospitalization in heart failure with preserved ejection fraction compared with reduced ejection fraction. Heart Vessels 5:595–603

    Article  Google Scholar 

Download references

Acknowledgements

We thank Ms. Marie Guinoiseau, R.N. and Ms. Valérie Le Moal, R.N. from the Rennes University Hospital, for their contributions in data collection for this study, and Pr. Nicolas Danchin (chairman), Ms. Geneviève Mulak, Ms. Elodie Drouet, and Mr. Hakeem F. Admane, from the Department of Registries of the French Society of Cardiology, for their assistance in study management. The KaRen study was supported, in part, by a Grant from Medtronic Inc. Europe (Medtronic Bakken Research Center, Maastricht, The Netherlands), and by Grants from the French Federation of Cardiology/French Society of Cardiology, France.

The following investigators and institutions participated in the KaRen study:

Principal Investigators: Erwan Donal and Lars H Lund.

Co-investigators:

France: Christophe Leclercq, CHU Rennes; Pascal de Groote and Pierre-Vladimir Ennezat, CHU Lille; Stéphane Lafitte and Patricia Réant, CHU Bordeaux; Fabrice Bauer, CHU Rouen, Geneviève Derumeaux and Cyrille Bergerot, CHU Lyon; Christian de Place, CHU Rennes; Yves Juilliere and Christine Selton-Suty, CHU Nancy; Damien Logeart, Hôpital Lariboisière, Paris; Pascal Gueret and Pascal Lim, Hôpital Henri Mondor, Créteil; Jean-Noel Trochu, and Nicolas Pirou, CHU Nantes; Gilbert Habib, Hôpital La Timone, Marseille; Francois Tournoux, Hôpital Lariboisiére, Paris.

Sweden: Ida Haugen-Löfman and Magnus Edner, Karolinska University hospital, Stockholm; Hans Emtell, Danderyd Hospital, Stockholm.

Author information

Author notes

    Authors and Affiliations

    1. Cardiology Department and CIC-IT U 804, Hôpital Pontchaillou, Rennes University Health Center, Rue Henri Le Guillou, 35000, Rennes, France

      Christian Bosseau, Erwan Donal & Jean-Claude Daubert

    2. Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

      Lars H. Lund, Camilla Hage & Cecilia Linde

    3. Clinical Investigation Center INSERM CIC-1414, CHU Rennes, Rennes, France

      Emmanuel Oger

    4. LTSI, Rennes 1 University, INSERM 1099, Rennes, France

      Christian Bosseau, Erwan Donal & Jean-Claude Daubert

    5. French Society of Cardiology, Paris, France

      Geneviève Mulak

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    1. Christian Bosseau
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    Consortia

    On behalf of the KaRen investigators

    • Erwan Donal
    • , Lars H. Lund
    • , Christophe Leclercq
    • , Pascal de Groote
    • , Pierre-Vladimir Ennezat
    • , Stéphane Lafitte
    • , Patricia Réant
    • , Fabrice Bauer
    • , Geneviève Derumeaux
    • , Cyrille Bergerot
    • , Christian de Place
    • , Yves Juillière
    • , Christine Selton-Suty
    • , Damien Logeart
    • , Pascal Gueret
    • , Pascal Lim
    • , Jean-Noël Trochu
    • , Nicolas Pirou
    • , Gilbert Habib
    • , François Tournoux
    • , Ida Haugen-Löfman
    • , Magnus Edner
    •  & Hans Emtell

    Corresponding author

    Correspondence to Christian Bosseau.

    Ethics declarations

    Conflict of interest

    There are no commercial products involved in this study. However, to the extent that findings in KaRen may affect the use of heart failure drugs or devices, we disclose the following: LHL: research Grants and/or speaker and/or consulting honoraria from AstraZeneca, Novartis, Boston Scientific, and St Jude Medical; CL: principal investigator of REVERSE, a CRT study sponsored by Medtronic research Grants, speaker honoraria, and consulting fees from Medtronic, speaker honoraria, and consulting fees from St. Jude Medical; ED: speaker honoraria and consulting fees from Novartis, Bristol-Myer Squibb; JCD: research Grants, speaker honoraria, and consulting fees from Medtronic and St Jude Medical. All other authors have no conflict of interest to declare.

    Additional information

    C. Bosseau and E. Donal contributed equally to this study.

    The members of the group “KaRen investigators” are listed in Acknowledgements.

    Appendices

    Appendix 1: Flowchart of the study

    Appendix 2: Survival based on treatments and heart rate

    Survival from the primary study endpoint based on…

    Hazard Ratio

    Confidence interval, 95%

    Survival curve†

    p

    Treatment with ACE inhibitor or ARB (yes or no)

    1.03

    0.73–1.45

    1

    0.52

    Heart rate (divided into tertiles)

    1

    0.99–1.01

    2

    0.78

    Anticoagulant treatment in overall population (yes or no)

    1.05

    0.78–1.42

    3

    0.52

    1. †See Fig. 2 for survival curves.

    Appendix 3: Survival in AF according to treatments: anticoagulation regimen and ACE inhibitors and ARB

    Appendix 4: Illustration of main echocardiographic characteristics of our population

    Full characteristics in Table 3.

    Adapted from Patrick J. Lynch, illustrator and C. Carl Jaffe, MD; cardiologist Yale University Center.

    Appendix 5: Echocardiographic characteristics of patients who converted from AF to sinus and sinus to AF

    Characteristics†

    Sinus rhythm

    SR‡ to AF

    AF to SR

    AF

    p

    N = 193

    N = 12

    N = 36

    N = 114

    General characteristics

     Inter ventricular septal thickness

    11.65 ± 2.27

    11.14 ± 2.54

    11.69 ± 2.28

    11.71 ± 2.26

    0.9356

     LV end diastolic diameter

    47.38 ± 6.64

    51.00 ± 7.83

    47.19 ± 6.17

    47.02 ± 5.17

    0.4319

     LV end systolic diameter

    31.54 ± 6.51

    36.86 ± 6.67

    31.40 ± 7.34

    32.53 ± 5.98

    0.1299

     LV mass indexed

    130.50 ± 39.30

    133.00 ± 16.09

    118.17 ± 20.55

    122.54 ± 33.49

    0.3318

     Stroke volume

    32.79 ± 9.45

    30.95 ± 7.70

    31.14 ± 7.48

    29.05 ± 7.34

    0.0404

     LAVI

    43.88 ± 13.90

    52.41 ± 10.66

    47.79 ± 14.55

    54.69 ± 17.40

    <0.0001

     RA area

    18.31 ± 5.45

    23.38 ± 7.84

    19.15 ± 5.54

    24.12 ± 4.97

    <0.0001

     Tricuspid regurgitation

    2.84 ± 0.66

    2.95 ± 0.70

    2.93 ± 0.80

    2.97 ± 0.51

    0.5346

    Diastolic function (E, e′)

     E-wave deceleration time

    219.34 ± 78.53

    162.50 ± 59.51

    199.45 ± 63.85

    160.18 ± 68.96

    <0.0001

     Early diastolic E-prime mean velocity

    7.09 ± 2.29

    9.19 ± 3.15

    7.63 ± 1.99

    9.53 ± 2.41

    <0.0001

     E/e′ ratio

    13.29 ± 5.97

    12.34 ± 4.67

    13.84 ± 5.68

    11.65 ± 5.52

    0.1270

    Right ventricular function

     TAPSE

    18.81 ± 4.42

    14.38 ± 3.20

    18.52 ± 4.59

    14.50 ± 3.54

    <0.0001

     Systolic peak velocity /tricuspid annulus

    11.73 ± 2.98

    9.29 ± 1.80

    11.52 ± 3.12

    10.05 ± 2.64

    <0.0001

     S′

    6.81 ± 1.57

    5.81 ± 1.62

    6.89 ± 1.83

    6.28 ± 1.50

    0.0208

    2-D speckle strain analysis

     LV deformation 2D strain

    −15.45 ± 3.76

    −13.94 ± 3.32

    −15.72 ± 4.26

    −12.60 ± 3.42

    <0.0001

     RV GLS

    −20.84 ±4.79

    −10.83 ± 3.55

    −20.31 ± 6.79

    −16.24 ± 4.44

    <0.0001

    Miscellaneous

     LV pre-ejection time interval

    78.03 ± 28.12

    103.50 ± 24.70

    81.21 ± 26.64

    88.95 ± 23.72

    0.0016

     Delay latero-septal 2D strain

    18.85 ± 268.70

    24.38 ± 56.28

    11.04 ± 108.93

    17.29 ± 107.66

    0.9982

    1. †See Table 3 for legends. ‡ SR stands for Sinus Rhythm

    Appendix 6: Clinical characteristics of patients who converted from AF to sinus and sinus to AF

    Characteristics†

    SR

    N = 193

    SR‡ to AF

    N = 12

    AF to SR

    N = 36

    AF

    N = 114

    p

    Age, years

    75.30 (9.65)

    76.67 (8.77)

    77.17 (10.77)

    77.52 (7.69)

    0.2004

    Gender, female (%)

    53.9 (104)

    75 (9)

    61.1 (22)

    51.8 (59)

    0.3851

    NYHA (stable condition), % (n)

     Class I

    14.5 (28)

    0 (0)

    16.7 (6)

    10.5 (12)

    0.3837

     Class II

    61.1 (118)

    91.7 (11)

    58.3 (21)

    57.9 (66)

    		 

     Class III

    18.7 (36)

    8.3 (1)

    19.4 (7)

    27.2 (31)

    		 

     Class IV

    2.6 (5)

    0 (0)

    0 (0)

    1.8 (2)

    		 

    BNP/NT-pro-BNP, n (%)

    <206 or <1118 ng/mL

    97 (50.3)

    2 (16.7)

    13 (36.1)

    20 (17.5)

    <0.0001*

     206–333 or 1118–1972

    23 (11.9)

    2 (16.7)

    8 (22.2)

    33 (28.9)

    		 

     333–555 or 1972–3087

    17 (8.8)

    5 (41.7)

    5 (13.9)

    26 (22.8)

    		 

     555–971 or 3087–5670

    14 (7.3)

    1 (8.3)

    2 (5.6)

    19 (16.7)

    		 

     >971 or >5670

    8 (4.1)

    1 (8.3)

    1 (2.8)

    5 (4.4)

    		 

     MDRD, mL/min

    61.49 (41.30)

    60.25 (34.78)

    68.17 (29.01)

    65.11 (25.88)

    0.6844

     LVEF, %

    62.73 (6.86)

    57.29 (8.99)

    64.56 (7.06)

    61.31 (6.63)

    0.0269

    Comorbidities, n (%)

     Coronary artery disease

    34.7 (67)

    25 (3)

    22.2 (8)

    26.3 (30)

    0.2857

     Myocardial infarction

    15.5 (30)

    8.3 (1)

    11.1 (4)

    13.2 (15)

    0.7351

     Stroke

    8.8 (17)

    8.3 (1)

    2.8 (1)

    14.9 (17)

    0.1442

     Anemia

    39.4 (76)

    25 (3)

    27.8 (10)

    35.1 (40)

    0.4802

     Diabetes mellitus

    33.2 (64)

    16.7 (2)

    19.4 (7)

    28.9 (33)

    0.2712

     Hypertension

    77.2 (149)

    58.3 (7)

    63.9 (23)

    83.3 (95)

    0.0359

     COPD

    9.3 (18)

    8.3 (1)

    13.9 (5)

    17.5 (20)

    0.1940

    History of valve disease

    19.7 (38)

    0 (0)

    11.1 (4)

    16.7 (19)

    0.2313

    Treatments, n (%)

     Anti-arrhythmics

    19.7 (38)

    33.3 (4)

    27.8 (10)

    12.3 (14)

    0.0806

     Beta-blockers

    76.2 (147)

    83.3 (10)

    77.8 (28)

    80.7 (92)

    0.7185

     Digoxin

    0.5 (1)

    8.3 (1)

    16.7 (6)

    22.8 (26)

    <0.0001*

     Statin therapy

    46.6 (90)

    41.7 (5)

    27.8 (10)

    42.1 (48)

    0.2167

     Potassion-sparing diuretics

    15 (29)

    16.7 (2)

    11.1 (4)

    19.3 (22)

    0.6192

     Loop-acting diuretic standing

    79.3 (153)

    83.3 (10)

    77.8 (28)

    87.7 (100)

    0.1966

    1. †See Table 1 for legends and details. ‡ SR stands for Sinus Rhythm

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    Bosseau, C., Donal, E., Lund, L.H. et al. The prognostic significance of atrial fibrillation in heart failure with preserved ejection function: insights from KaRen, a prospective and multicenter study. Heart Vessels 32, 735–749 (2017). https://doi.org/10.1007/s00380-016-0933-8

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