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3.
Nat Commun ; 11(1): 4992, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020487

RESUMO

Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in utero approaches are compromised by spontaneous fetal motion. Here, we present and validate a novel method of MRI velocity-encoding combined with a motion-robust reconstruction framework for four-dimensional visualization and quantification of blood flow in the human fetal heart and major vessels. We demonstrate simultaneous 4D visualization of the anatomy and circulation, which we use to quantify flow rates through various major vessels. The framework introduced here could enable new clinical opportunities for assessment of the fetal cardiovascular system in both health and disease.


Assuntos
Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiologia , Tomografia Computadorizada Quadridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Velocidade do Fluxo Sanguíneo , Vasos Sanguíneos/diagnóstico por imagem , Vasos Sanguíneos/fisiologia , Feminino , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Imagens de Fantasmas , Gravidez , Diagnóstico Pré-Natal
5.
Radiol Med ; 125(11): 1040-1055, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32939626

RESUMO

Cardiac magnetic resonance (CMR) imaging is an effective method for noninvasively imaging the heart which in the last two decades impressively enhanced spatial and temporal resolution and imaging speed, broadening its spectrum of applications in cardiovascular disease. CMR imaging techniques are designed to noninvasively assess cardiovascular morphology, ventricular function, myocardial perfusion, tissue characterization, flow quantification and coronary artery disease. These intrinsic features yield CMR suitable for diagnosis, follow-up and longitudinal monitoring after treatment of cardiovascular diseases. The aim of this paper is to review the technical basis of CMR, from cardiac imaging planes to cardiac imaging sequences.


Assuntos
Coração/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Técnicas de Imagem Cardíaca/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Frequência Cardíaca , Humanos , Imageamento Tridimensional , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Contração Miocárdica , Imagem de Perfusão do Miocárdio , Técnicas de Imagem de Sincronização Respiratória , Fatores de Tempo
6.
Echocardiography ; 37(10): 1673-1677, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32986881

RESUMO

We report the case of a healthy 35-year-old woman who had experienced a flu-like syndrome during the week before childbirth and heart failure symptoms 10 days before the current hospitalization and presented to our emergency department with clinical signs of congestive heart failure, echocardiographic evidence of a severely dilated and hypokinetic heart, laboratory evidence of SARS-CoV-2 disease, and radiologic findings consistent with both virus-related pneumonia and heart failure. Early cardiac magnetic resonance was crucial for the diagnosis of postpartum cardiomyopathy and for the exclusion of virus-related myocarditis, allowing us to decide on a prudent and supportive clinical approach.


Assuntos
Betacoronavirus , Cardiomiopatias/diagnóstico , Infecções por Coronavirus/complicações , Eletrocardiografia/métodos , Miocardite/diagnóstico , Período Periparto , Pneumonia Viral/complicações , Complicações Cardiovasculares na Gravidez/diagnóstico , Doença Aguda , Adulto , Cardiomiopatias/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Tomografia Computadorizada por Raios X
7.
Pediatr Clin North Am ; 67(5): 821-842, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888684

RESUMO

Left-to-right shunts represent a significant portion of congenital heart disease. Such lesions are common in isolation, but are frequently seen in conjunction with other, often more complex, congenital heart disease. This review covers basic anatomy, physiology, physical examination findings, diagnosis and management for atrial septal defects, ventricular septal defects, and patent ductus arteriosa.


Assuntos
Ecocardiografia/métodos , Forame Oval Patente/diagnóstico , Comunicação Interatrial/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Criança , Humanos
9.
JACC Cardiovasc Imaging ; 13(8): 1792-1808, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32762885

RESUMO

The severe acute respiratory syndrome-coronavirus-2 outbreak has rapidly reached pandemic proportions and has become a major threat to global health. Although the predominant clinical feature of coronavirus disease-2019 (COVID-19) is an acute respiratory syndrome of varying severity, ranging from mild symptomatic interstitial pneumonia to acute respiratory distress syndrome, the cardiovascular system can be involved in several ways. As many as 40% of patients hospitalized with COVID-19 have histories of cardiovascular disease, and current estimates report a proportion of myocardial injury in patients with COVID-19 of up to 12%. Multiple pathways have been suggested to explain this finding and the related clinical scenarios, encompassing local and systemic inflammatory responses and oxygen supply-demand imbalance. From a clinical point of view, cardiac involvement during COVID-19 may present a wide spectrum of severity, ranging from subclinical myocardial injury to well-defined clinical entities (myocarditis, myocardial infarction, pulmonary embolism, and heart failure), whose incidence and prognostic implications are currently largely unknown because of a significant lack of imaging data. Integrated heart and lung multimodality imaging plays a central role in different clinical settings and is essential in the diagnosis, risk stratification, and management of patients with COVID-19. The aims of this review are to summarize imaging-oriented pathophysiological mechanisms of lung and cardiac involvement in COVID-19 and to provide a guide for integrated imaging assessment in these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Cardiopatias/diagnóstico , Coração/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Imagem Multimodal/métodos , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Saúde Global , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Incidência , Imagem Cinética por Ressonância Magnética/métodos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Tomografia Computadorizada por Raios X/métodos
10.
Korean J Radiol ; 21(8): 978-986, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677382

RESUMO

OBJECTIVE: To compare native and post-contrast T1 mapping with late gadolinium enhancement (LGE) imaging for detecting and measuring the microvascular obstruction (MVO) area in reperfused acute myocardial infarction (MI). MATERIALS AND METHODS: This study included 20 patients with acute MI who had undergone 1.5T cardiovascular magnetic resonance imaging (CMR) after reperfusion therapy. CMR included cine imaging, LGE, and T1 mapping (modified look-locker inversion recovery). MI size was calculated from LGE by full-width at half-maximum technique. MVO was defined as an area with low signal intensity (LGE) or as a region of visually distinguishable T1 values (T1 maps) within infarcted myocardium. Regional T1 values were measured in MVO, infarcted, and remote myocardium on T1 maps. MVO area was measured on and compared among LGE, native, and post-contrast T1 maps. RESULTS: The mean MI size was 27.1 ± 9.7% of the left ventricular mass. Of the 20 identified MVOs, 18 (90%) were detected on native T1 maps, while 10 (50%) were recognized on post-contrast T1 maps. The mean native T1 values of MVO, infarcted, and remote myocardium were 1013.5 ± 58.5, 1240.9 ± 55.8 (p < 0.001), and 1062.2 ± 55.8 ms (p = 0.169), respectively, while the mean post-contrast T1 values were 466.7 ± 26.8, 399.1 ± 21.3, and 585.2 ± 21.3 ms, respectively (p < 0.001). The mean MVO areas on LGE, native, and post-contrast T1 maps were 134.1 ± 81.2, 133.7 ± 80.4, and 117.1 ± 53.3 mm², respectively. The median (interquartile range) MVO areas on LGE, native, and post-contrast T1 maps were 128.0 (58.1-215.4), 110.5 (67.7-227.9), and 143.0 (76.7-155.3) mm², respectively (p = 0.002). Concordance correlation coefficients for the MVO area between LGE and native T1 maps, LGE and post-contrast T1 maps, and native and post-contrast T1 maps were 0.770, 0.375, and 0.565, respectively. CONCLUSION: MVO areas were accurately delineated on native T1 maps and showed high concordance with the areas measured on LGE. However, post-contrast T1 maps had low detection rates and underestimated MVO areas. Collectively, native T1 mapping is a useful tool for detecting MVO within the infarcted myocardium.


Assuntos
Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Adulto , Meios de Contraste , Feminino , Gadolínio , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/patologia , Miocárdio/patologia
11.
Methodist Debakey Cardiovasc J ; 16(2): 146-154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670475

RESUMO

Since early 2020, the world has been facing a pandemic caused by the novel coronavirus SARS-CoV-2. Although this positive single-stranded RNA virus primarily causes pulmonary infection and failure, it has been associated with multiple cardiovascular diseases including troponin elevation, myocarditis, and cardiac arrhythmias. Cardiac patients are susceptible to developing more severe infection from SARS-COV-2, making management complicated. In this review we discuss the cardiac manifestations of COVID-19 infections as well as considerations for the management of primary cardiac pathologies during this pandemic.


Assuntos
Doenças Cardiovasculares/epidemiologia , Causas de Morte , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Doenças Cardiovasculares/diagnóstico por imagem , China/epidemiologia , Comorbidade , Infecções por Coronavirus/prevenção & controle , Feminino , Saúde Global , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Miocardite/diagnóstico , Miocardite/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevalência , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Troponina T/sangue , Populações Vulneráveis/estatística & dados numéricos
12.
JACC Cardiovasc Imaging ; 13(7): 1615-1626, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32646721
13.
J Comput Assist Tomogr ; 44(4): 591-598, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697530

RESUMO

BACKGROUND: Cardiac strain represents an imaging biomarker of contractile dysfunction. PURPOSE: The purpose of this study was to investigate the diagnostic value of cardiac strain obtained by feature-tracking cardiac magnetic resonance (MR) in acute myocarditis. MATERIALS AND METHODS: Cardiac MR examinations of 46 patients with myocarditis and preserved ejection fraction at acute phase and follow-up were analyzed along with cardiac MR of 46 healthy age- and sex-matched controls. Global circumferential strain and global radial strain were calculated for each examination, along with myocardial edema and late gadolinium enhancement, and left ventricle functional parameters, through manual contouring of the myocardium. Correlations were assessed using Spearman ρ. Wilcoxon and Mann-Whitney U test were used to assess differences between data. Receiver operating characteristics curves and reproducibility were obtained to assess the diagnostic role of strain parameters. RESULTS: Global circumferential strain was significantly lower in controls (median, -20.4%; interquartile range [IQR], -23.4% to -18.7%) than patients in acute phase (-18.4%; IQR, -21.0% to -16.1%; P = 0.001) or at follow-up (-19.2%; IQR, -21.5% to -16.1%; P = 0.020). Global radial strain was significantly higher in controls (82.4%; IQR, 62.8%-104.9%) than in patients during the acute phase (65.8%; IQR, 52.9%-79.5%; P = 0.001). Correlations were found between global circumferential strain and global radial strain in all groups (acute, ρ = -0.580, P < 0.001; follow-up, ρ = -0.399, P = 0.006; controls, ρ = -0.609, P < 0.001), and between global circumferential strain and late gadolinium enhancement only in myocarditis patients (acute, ρ = 0.035, P = 0.024; follow-up, ρ = 0.307, P = 0.038). CONCLUSIONS: Cardiac strain could potentially have a role in detecting acute myocarditis in low-risk acute myocarditis patients where cardiac MR is the main diagnosing technique.


Assuntos
Imagem Cinética por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Miocardite/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Volume Sistólico , Adulto Jovem
14.
G Ital Cardiol (Rome) ; 21(8): 594-597, 2020 Aug.
Artigo em Italiano | MEDLINE | ID: mdl-32686784

RESUMO

Severe acute respiratory syndrome coronavirus 2 may affect the cardiovascular system and cause acute cardiac injury. Other authors described cases of myocarditis with reduced systolic function and/or a life-threatening presentation. We describe the clinical course of an unusual presentation with isolated reversible high degree atrioventricular block in a patient with COVID-19. In this case, a "wait and see approach" avoided an unnecessary permanent pacemaker implantation.


Assuntos
Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/diagnóstico por imagem , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Conduta Expectante , Infecções por Coronavirus/diagnóstico , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Itália , Imagem Cinética por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo
15.
Radiol Med ; 125(9): 838-850, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32671554

RESUMO

4D Flow is an emerging MR technique enabling three-dimensional and cardiac phase-resolved flowmetry with ECG-gated phase-contrast MRI that increased the speed of data acquisitions, accuracy and robustness. The method is promoting researches in areas that have not been fully addressed before in the cardiovascular system, such as flowmetry of the bloodstream across the valves, within the heart chambers, complexed flow dynamics such as vortex, helical or retrograde. Wall shear stress and other potential biomarkers derived from 4D Flow are known to be related to vascular wall diseases such as atherosclerosis. In this review, fundamental concepts of 4D Flow technique and post-processing, benefits and limitations as well as its clinical applications are discussed, and the importance of quality control and validation of the method is emphasized. New ideas inspired by 4D Flow can help clinicians and MR scientists further understand the role of flow dynamics in health sciences, diseases and various aspects of cardiovascular physiology.


Assuntos
Circulação Coronária/fisiologia , Imagem Cinética por Ressonância Magnética/métodos , Velocidade do Fluxo Sanguíneo , Eletrocardiografia/métodos , Humanos , Hidrodinâmica , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Fluxo Sanguíneo Regional/fisiologia , Resistência ao Cisalhamento/fisiologia
16.
Can J Cardiol ; 36(8): 1326.e5-1326.e7, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32522523
17.
Clin Imaging ; 66: 121-126, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32480266

RESUMO

BACKGROUND AND PURPOSE: Subendocardial fibrosis is recognized finding in left ventricular noncompaction (LVNC); however, the evidence regarding the patterns and the frequency of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMRI) is controversial. The present study sought to assess the frequency and patterns of LGE in LVNC. MATERIALS AND METHODS: Patients with a diagnosis of LVNC based on the echocardiographic CMRI criteria were enrolled in this retrospective study. The myocardial noncompacted-to-compacted ratio (NC/C) was perpendicularly measured on short-axis cine images. Two observers jointly assessed the presence of LGE on short-axis LGE images. The long-axis four-chamber and long-axis two-chamber images were used to confirm the presence of LGE if needed. RESULTS: A total of 42 patients, 20 females (47.7%) and 22 were males (52.3%), were included in the study. The median age of the patients was 32.4 years (range 18-63). LGE was identified in 2 out of 42 patients (4.7%) with LVNC. LGE was identified in the interventricular septum involving the subendocardial layer and noncompacted lateral myocardial wall involving the trabeculae at mid-ventricular and basal levels. CONCLUSION: LGE is uncommon in patients with LVNC. We highlight that the diagnosis of LVNC in patients with atypical LGE patterns, such as epicardial or transmural enhancement, should be reappraised and the other cardiac diseases should be discarded before establishing the final diagnosis.


Assuntos
Gadolínio , Imagem Cinética por Ressonância Magnética/métodos , Adolescente , Adulto , Meios de Contraste , Ecocardiografia , Feminino , Fibrose , Coração , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Aumento da Imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Estudos Retrospectivos , Adulto Jovem
18.
Ann Hematol ; 99(9): 2009-2017, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32556452

RESUMO

The consequence of regular blood transfusion in patients with thalassemia major (TM) is iron overload. Herein, we report the long-term impact of chelation on liver iron concentration (LIC) and cardiac T2* MR in patients with TM. This is a retrospective cohort study over 10 years of adolescents and adults with TM aged at least 10 years who had their first cardiac T2* MR between September 2006 and February 2007. One-year chelation therapy was considered the unit of analysis. A total of 99 patients were included in this study with a median age of 18 years. The median cardiac T2* MR and LIC at baseline were 19 ms and 11.6 mg/g dw, respectively. During follow-up, 18 patients died and six underwent successful bone marrow transplantation. Factors associated with decreased survival were older age (HR 1.12, p = 0.014) and high risk cardiac T2* (HR 8.04, p = 0.004). The median cardiac T2* and LIC significantly improved over the 10-year follow-up period (p = 0.000011 and 0.00072, respectively). In conclusion, this long-term "real-life" study confirms that low cardiac T2* adversely impacts the overall survival in patients with TM. Higher baseline LIC predicts a larger reduction in LIC, and lower baseline cardiac T2* predicts a larger improvement in T2*.


Assuntos
Terapia por Quelação/tendências , Imagem Cinética por Ressonância Magnética/métodos , Talassemia beta/diagnóstico por imagem , Talassemia beta/tratamento farmacológico , Adolescente , Terapia por Quelação/métodos , Estudos de Coortes , Deferasirox/uso terapêutico , Deferiprona/uso terapêutico , Feminino , Seguimentos , Humanos , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/diagnóstico por imagem , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/mortalidade , Masculino , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto Jovem , Talassemia beta/mortalidade
19.
Sci Rep ; 10(1): 8465, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439884

RESUMO

Curvature-based three-dimensional cardiovascular magnetic resonance (CMR) allows regional function characterization without an external spatial frame of reference. However, introduction of this modality into clinical practice is hampered by lack of reference values. We aim to establish normal ranges for 3D left ventricular (LV) regional parameters in relation to age and gender for 171 healthy subjects. LV geometrical reconstruction and automatic calculation of regional parameters were implemented by in-house software (CardioWerkz) using stacks of short-axis cine slices. Parameter normal ranges were stratified by gender and age categories (≤44, 45-64, 65-74 and 75-84 years). Our software had excellent intra- and inter-observer agreement. Ageing was significantly associated with increases in end-systolic (ES) curvedness (CES) and area strain (AS) with higher rates of increase in males, end-diastolic (ED) and ES wall thickness (WTED, WTES) with higher rates of increase in females, and reductions in ED and ES wall stress indices (σi,ED) with higher rates of increase in females. Females exhibited greater ED curvedness, CES, σi,ED and AS than males, but smaller WTED and WTES. Age × gender interaction was not observed for any parameter. This study establishes age and gender specific reference values for 3D LV regional parameters using CMR without additional image acquisition.


Assuntos
Ventrículos do Coração/fisiopatologia , Imagem Cinética por Ressonância Magnética/métodos , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Adulto Jovem
20.
Eur Heart J Cardiovasc Imaging ; 21(7): 709-714, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391912

RESUMO

Recent EACVI recommendations described the importance of limiting cardiovascular imaging during the COVID-19 pandemic in order to reduce virus transmission, protect healthcare professionals from contamination, and reduce consumption of personal protective equipment. However, an elevated troponin remains a frequent request for cardiac imaging in COVID-19 patients, partly because it signifies cardiac injury due to a variety of causes and partly because it is known to convey a worse prognosis. The present paper aims to provide guidance to clinicians regarding the appropriateness of cardiac imaging in the context of troponin elevation and myocardial injury, how best to decipher the mechanism of myocardial injury, and how to guide patient management.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Infecções por Coronavirus/epidemiologia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Troponina I/sangue , Biomarcadores , Técnicas de Imagem Cardíaca/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/prevenção & controle , Gerenciamento Clínico , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler/estatística & dados numéricos , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Prognóstico , Medição de Risco , Papel (figurativo)
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