e3f044aed3affaed62013a769136fbb8 317415.pdf cbda990fa4229c9c136c2e54ae4b38dedb772911 317415.pdf 4ca0c83cdab11ca296e2d5fab7abc95bd2d9e95a9311577b88023b28760d35ba 317415.pdf Title: Sex-related differences in severe native valvular heart disease: the ESC-EORP Valvular Heart Disease II survey Subject: DOI: 10.1093/eurheartj/ehae523; European Heart Journal, 45, 37, 2024-08-30.; Abstract: Background and Aims: To assess sex differences in disease characteristics and treatment of patients with severe native valvular heart disease (VHD) included in the VHD II EURObservational Research Programme. Methods: A total of 5219 patients were enrolled in 208 European and North African centres and followed for 6 months [41.2% aortic stenosis (AS), 5.3% aortic regurgitation (AR), 4.5% mitral stenosis (MS), 21.3% mitral regurgitation (MR), 2.7% isolated right-sided VHD, 24.9% multiple left-sided VHD]. Indications for intervention were considered concordant if corresponding to class I recommendations specified in the 2012 ESC or 2014 AHA/ACC VHD guidelines. Results: Overall, women were older, more symptomatic, and presented with a higher EuroSCORE II. Bicuspid aortic valve and AR were more prevalent among men while mitral disease, concomitant tricuspid regurgitation (TR), and AS above age 65 were Keywords: Sex differences; Valvular heart disease Author: Julia Mascherbauer Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 Producer: PDFlib+PDI 9.0.7p3 (C++/Win64) CreationDate: Thu Oct 3 06:12:30 2024 CEST ModDate: Fri Oct 4 12:08:51 2024 CEST Custom Metadata: yes Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: AcroForm JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 793.701 pts Page rot: 0 File size: 712426 bytes Optimized: yes PDF version: 1.6 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- FPUQBB+GillSansNova-Book CID TrueType Identity-H yes yes yes 2200 0 ZREFPW+GillSansNova-Bold CID TrueType Identity-H yes yes yes 2203 0 MMKIDP+GillSansNova-BookItalic CID TrueType Identity-H yes yes yes 2206 0 BPGJFA+GillSansNova-BoldItalic CID TrueType Identity-H yes yes yes 2209 0 AOGXIS+GillSansNova-Heavy CID TrueType Identity-H yes yes yes 2212 0 QSQNBA+STIXGeneral-Regular Type 1C Custom yes yes yes 2215 0 SNIWQS+GillSansNova-Book Type 1C Custom yes yes yes 205 0 SNIWQS+GillSansNova-Bold Type 1C WinAnsi yes yes yes 207 0 SNIWQS+GillSansNova-Book Type 1C Custom yes yes no 210 0 SNIWQS+GillSansNova-Medium Type 1C Custom yes yes no 213 0 FPELKX+TimesNewRomanPSMT CID TrueType Identity-H yes yes yes 298 0 VDNPDJ+STIXGeneral-Bold Type 1C Custom yes yes yes 301 0 VVSXJW+MyriadPro-Regular Type 1 Custom yes yes no 270 0 QKETUY+SourceSansPro-Regular Type 1C Custom yes yes yes 363 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-09-09 03:49:22 CEST RepresentationInformation: 317415.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-09-08 13:51:23 CEST Size: 712426 Format: PDF Version: 1.6 Status: Well-Formed, but not valid SignatureMatches: PDF-hul ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff5' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff9' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff6' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff8' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff7' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff3' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff2' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff10' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'affehae523-aff4' cannot be found ID: PDF-HUL-149 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff4' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff9' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff5' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff8' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff7' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff6' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff2' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff10' cannot be found ID: PDF-HUL-122 Offset: 700939 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'affehae523-aff3' cannot be found ID: PDF-HUL-122 Offset: 700939 MIMEtype: application/pdf Profile: Linearized PDF, Tagged PDF PDFMetadata: Objects: 0 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: false CenterWindow: false DisplayDocTitle: true NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: OneColumn PageMode: UseOutlines Language: en Outlines: Item: Title: Sex-related differences in severe native valvular heart disease: the ESC-EORP Valvular Heart Disease II survey Destination: head1 Children: Item: Title: Introduction Destination: secehae523-s1 Item: Title: Methods Destination: secehae523-s2 Children: Item: Title: Study design Destination: secehae523-s2.1 Item: Title: Patients Destination: secehae523-s2.2 Item: Title: Classification of valvular heart disease Destination: secehae523-s2.3 Item: Title: Statistical analysis Destination: secehae523-s2.4 Item: Title: Results Destination: secehae523-s3 Children: Item: Title: Patient characteristics Destination: secehae523-s3.1 Item: Title: Valvular heart disease characteristics Destination: secehae523-s3.2 Item: Title: Interventional treatment Destination: secehae523-s3.3 Item: Title: Clinical management strategies Destination: secehae523-s3.4 Item: Title: Decisions for interventions Destination: secehae523-s3.5 Item: Title: Survival Destination: secehae523-s3.6 Item: Title: Discussion Destination: secehae523-s4 Children: Item: Title: Sex differences in aortic valve disease Destination: secehae523-s4.1 Item: Title: Sex differences in mitral valve disease Destination: secehae523-s4.2 Item: Title: Sex differences in tricuspid valve disease Destination: secehae523-s4.3 Item: Title: Limitations Destination: secehae523-s4.4 Item: Title: Conclusions Destination: secehae523-s5 Item: Title: Acknowledgements Destination: acknow Item: Title: Declarations Destination: secehae523-s7 Children: Item: Title: Disclosure of Interest Destination: secehae523-s8 Item: Title: Data Availability Destination: secehae523-s9 Item: Title: Funding Destination: secehae523-s10 Item: Title: Ethical Approval Destination: secehae523-s11 Item: Title: Pre-registered Clinical Trial Number Destination: secehae523-s12 Item: Title: Appendix Destination: apnd Children: Item: Title: Destination: apndehae523-s6 Children: Item: Title: Group author list all names from all sub-groups should be downstreamed as collaborators to PubMed): EORP VHD II Registry Investigators Group Destination: apndehae523-s6.1 Item: Title: References Destination: reflist Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 881 ImageHeight: 1669 BitsPerSample: 8 BitsPerSampleUnit: integer Fonts: Type0: Font: BaseFont: BPGJFA+GillSansNova-BoldItalic Encoding: Identity-H ToUnicode: true Font: BaseFont: AOGXIS+GillSansNova-Heavy Encoding: Identity-H ToUnicode: true Font: BaseFont: FPUQBB+GillSansNova-Book Encoding: Identity-H ToUnicode: true Font: BaseFont: FPELKX+TimesNewRomanPSMT Encoding: Identity-H ToUnicode: true Font: BaseFont: ZREFPW+GillSansNova-Bold Encoding: Identity-H ToUnicode: true Font: BaseFont: MMKIDP+GillSansNova-BookItalic Encoding: Identity-H ToUnicode: true Type1: Font: BaseFont: QSQNBA+STIXGeneral-Regular FontSubset: true FirstChar: 1 LastChar: 7 FontDescriptor: FontName: QSQNBA+STIXGeneral-Regular Flags: Nonsymbolic FontBBox: -995, -455, 2000, 1055 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: QKETUY+SourceSansPro-Regular FontSubset: true FirstChar: 1 LastChar: 1 FontDescriptor: FontName: QKETUY+SourceSansPro-Regular Flags: Nonsymbolic FontBBox: -192, -323, 1160, 952 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: VDNPDJ+STIXGeneral-Bold FontSubset: true FirstChar: 1 LastChar: 1 FontDescriptor: FontName: VDNPDJ+STIXGeneral-Bold Flags: Nonsymbolic, ForceBold FontBBox: -1030, -455, 2000, 1055 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true CIDFontType2: Font: BaseFont: BPGJFA+GillSansNova-BoldItalic CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: BPGJFA+GillSansNova-BoldItalic Flags: Nonsymbolic, Italic, ForceBold FontBBox: -404, -250, 1219, 960 FontFile2: true Font: BaseFont: AOGXIS+GillSansNova-Heavy CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: AOGXIS+GillSansNova-Heavy Flags: Nonsymbolic, ForceBold FontBBox: -504, -287, 1375, 966 FontFile2: true Font: BaseFont: FPUQBB+GillSansNova-Book CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: FPUQBB+GillSansNova-Book Flags: Nonsymbolic FontBBox: -420, -251, 1219, 950 FontFile2: true Font: BaseFont: FPELKX+TimesNewRomanPSMT CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: FPELKX+TimesNewRomanPSMT Flags: Nonsymbolic FontBBox: -568, -307, 2046, 1040 FontFile2: true Font: BaseFont: ZREFPW+GillSansNova-Bold CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: ZREFPW+GillSansNova-Bold Flags: Nonsymbolic, ForceBold FontBBox: -476, -276, 1276, 961 FontFile2: true Font: BaseFont: MMKIDP+GillSansNova-BookItalic CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: MMKIDP+GillSansNova-BookItalic Flags: Nonsymbolic, Italic FontBBox: -316, -235, 1219, 950 FontFile2: true XMP: uuid:14ba76d8-2fed-444f-a489-671bc8038c6b uuid:E9808FFA-2C25-D6DA-6816-E7A91F735566 True Sex differences; Valvular heart disease PDFlib+PDI 9.0.7p3 (C++/Win64) application/pdf 10.1093/eurheartj/ehae523 en Oxford University Press Sex-related differences in severe native valvular heart disease: the ESC-EORP Valvular Heart Disease II survey Julia Mascherbauer Andreas Kammerlander Christian Nitsche Jeroen Bax Victoria Delgado Arturo Evangelista Cecile Laroche Aldo Pietro Maggioni Julien Magne Alec Vahanian Bernard Iung DOI: 10.1093/eurheartj/ehae523; European Heart Journal, 45, 37, 2024-08-30.; Abstract: Background and Aims: To assess sex differences in disease characteristics and treatment of patients with severe native valvular heart disease (VHD) included in the VHD II EURObservational Research Programme. Methods: A total of 5219 patients were enrolled in 208 European and North African centres and followed for 6 months [41.2% aortic stenosis (AS), 5.3% aortic regurgitation (AR), 4.5% mitral stenosis (MS), 21.3% mitral regurgitation (MR), 2.7% isolated right-sided VHD, 24.9% multiple left-sided VHD]. Indications for intervention were considered concordant if corresponding to class I recommendations specified in the 2012 ESC or 2014 AHA/ACC VHD guidelines. Results: Overall, women were older, more symptomatic, and presented with a higher EuroSCORE II. Bicuspid aortic valve and AR were more prevalent among men while mitral disease, concomitant tricuspid regurgitation (TR), and AS above age 65 were © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. Sex differences Valvular heart disease Journal European Heart Journal © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. 0195-668X 1522-9645 45 37 3818 3833 10.1093/eurheartj/ehae523 https://doi.org/10.1093/eurheartj/ehae523 2024-10-03T09:42:30+05:30 2024-10-04T15:38:51+05:30 Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 2024-10-04T15:38:51+05:30 PStill version 1.84.42 1 PDF/UA Universal Accessibility Schema http://www.aiim.org/pdfua/ns/id/ pdfuaid part Integer internal Indicates, which part of ISO 14289 standard is followed Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 157, 581, 167, 591 Flags: Print Annotation: Subtype: Link Rect: 170, 584, 175, 597 Flags: Print Destination: 2151 Annotation: Subtype: Link Rect: 338, 584, 343, 597 Flags: Print Destination: null Annotation: Subtype: Link Rect: 462, 581, 472, 591 Flags: Print Annotation: Subtype: Link Rect: 474, 584, 480, 597 Flags: Print Destination: null Annotation: Subtype: Link Rect: 104, 568, 109, 581 Flags: Print Destination: null Annotation: Subtype: Link Rect: 219, 568, 225, 581 Flags: Print Destination: null Annotation: Subtype: Link Rect: 348, 568, 353, 581 Flags: Print Destination: null Annotation: Subtype: Link Rect: 451, 568, 457, 581 Flags: Print Destination: null Annotation: Subtype: Link Rect: 166, 552, 172, 565 Flags: Print Destination: null Annotation: Subtype: Link Rect: 261, 549, 271, 559 Flags: Print Annotation: Subtype: Link Rect: 273, 552, 279, 565 Flags: Print Destination: null Annotation: Subtype: Link Rect: 373, 552, 379, 565 Flags: Print Destination: null Annotation: Subtype: Link Rect: 493, 552, 504, 565 Flags: Print Destination: null Annotation: Subtype: Link Rect: 62, 425, 239, 434 Flags: Print Annotation: Subtype: Link Rect: 285, 73, 392, 80 Flags: Print Annotation: Subtype: Link Rect: 330, 55, 453, 62 Flags: Print Page: Sequence: 2 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 136, 684, 139, 693 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 143, 684, 146, 693 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 233, 661, 237, 670 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 238, 661, 241, 670 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 203, 638, 206, 647 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 207, 638, 211, 647 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 57, 546, 60, 555 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 253, 523, 256, 532 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 258, 523, 261, 532 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 56, 477, 59, 486 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 72, 342, 75, 350 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 53, 123, 56, 132 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 57, 123, 60, 132 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 529, 448, 532, 456 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 533, 448, 536, 456 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 303, 222, 330, 231 Flags: Print Destination: 63 Annotation: Subtype: Link Rect: 337, 57, 363, 66 Flags: Print Destination: 68 Page: Sequence: 4 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 36, 690, 64, 699 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 57, 659, 60, 668 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 471, 379, 497, 388 Flags: Print Destination: 68 Annotation: Subtype: Link Rect: 303, 333, 328, 342 Flags: Print Destination: 127 Annotation: Subtype: Link Rect: 428, 115, 459, 124 Flags: Print Destination: 130 Annotation: Subtype: Link Rect: 544, 96, 548, 105 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 549, 96, 552, 105 Flags: Print Destination: 159 Page: Sequence: 6 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 120, 499, 152, 508 Flags: Print Destination: 130 Annotation: Subtype: Link Rect: 36, 462, 62, 471 Flags: Print Destination: 130 Annotation: Subtype: Link Rect: 229, 359, 256, 368 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 69, 207, 99, 216 Flags: Print Destination: 147 Annotation: Subtype: Link Rect: 193, 161, 225, 170 Flags: Print Destination: 147 Annotation: Subtype: Link Rect: 175, 149, 206, 158 Flags: Print Destination: 147 Annotation: Subtype: Link Rect: 119, 92, 144, 101 Flags: Print Destination: 152 Annotation: Subtype: Link Rect: 39, 80, 64, 89 Flags: Print Destination: 154 Annotation: Subtype: Link Rect: 229, 80, 254, 89 Flags: Print Destination: 157 Annotation: Subtype: Link Rect: 251, 57, 285, 66 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 36, 46, 98, 55 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 494, 482, 497, 491 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 403, 424, 406, 433 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 407, 424, 411, 433 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 414, 424, 421, 433 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 549, 390, 552, 399 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 473, 303, 480, 312 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 432, 280, 439, 289 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 441, 253, 467, 262 Flags: Print Destination: 68 Annotation: Subtype: Link Rect: 468, 245, 474, 254 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 498, 188, 502, 197 Flags: Print Destination: 159 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 88, 73, 92, 82 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 433, 73, 440, 82 Flags: Print Destination: 159 Page: Sequence: 9 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 260, 374, 286, 383 Flags: Print Destination: 127 Annotation: Subtype: Link Rect: 260, 328, 286, 337 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 96, 309, 102, 318 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 104, 309, 110, 318 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 139, 286, 146, 295 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 255, 286, 261, 295 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 267, 206, 274, 215 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 91, 96, 98, 105 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 59, 73, 66, 82 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 106, 50, 113, 59 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 338, 717, 345, 726 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 373, 682, 380, 691 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 497, 671, 503, 680 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 364, 602, 371, 611 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 372, 602, 379, 611 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 381, 602, 387, 611 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 389, 579, 396, 588 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 397, 579, 404, 588 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 483, 521, 490, 530 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 543, 395, 550, 404 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 551, 395, 558, 404 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 428, 360, 435, 369 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 436, 360, 442, 369 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 444, 360, 450, 369 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 372, 314, 378, 323 Flags: Print Destination: 159 Annotation: Subtype: Link Rect: 405, 107, 412, 116 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 499, 50, 505, 59 Flags: Print Destination: 162 Annotation: Subtype: Link Rect: 507, 50, 513, 59 Flags: Print Destination: 162 Page: Sequence: 11 Page: Sequence: 12 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 197, 143, 230, 152 Flags: Print Destination: 157 Page: Sequence: 14 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 40, 307, 43, 314 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 221, 289, 285, 296 Flags: Print Annotation: Subtype: Link Rect: 48, 280, 141, 287 Flags: Print Annotation: Subtype: Link Rect: 40, 271, 43, 278 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 40, 226, 43, 233 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 202, 208, 285, 215 Flags: Print Annotation: Subtype: Link Rect: 48, 199, 96, 206 Flags: Print Annotation: Subtype: Link Rect: 40, 190, 43, 197 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 257, 172, 285, 179 Flags: Print Annotation: Subtype: Link Rect: 48, 163, 177, 170 Flags: Print Annotation: Subtype: Link Rect: 40, 154, 43, 161 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 183, 145, 285, 152 Flags: Print Annotation: Subtype: Link Rect: 48, 136, 80, 143 Flags: Print Annotation: Subtype: Link Rect: 40, 127, 43, 134 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 75, 109, 189, 116 Flags: Print Annotation: Subtype: Link Rect: 40, 100, 43, 107 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 184, 64, 282, 71 Flags: Print Annotation: Subtype: Link Rect: 40, 55, 43, 62 Flags: Print Destination: 58 Annotation: Subtype: Link Rect: 476, 717, 552, 724 Flags: Print Annotation: Subtype: Link Rect: 315, 708, 371, 715 Flags: Print Annotation: Subtype: Link Rect: 307, 699, 310, 706 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 367, 680, 482, 687 Flags: Print Annotation: Subtype: Link Rect: 303, 671, 310, 678 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 364, 653, 455, 660 Flags: Print Annotation: Subtype: Link Rect: 303, 644, 310, 651 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 364, 625, 474, 632 Flags: Print Annotation: Subtype: Link Rect: 303, 616, 310, 623 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 504, 598, 552, 605 Flags: Print Annotation: Subtype: Link Rect: 315, 588, 382, 595 Flags: Print Annotation: Subtype: Link Rect: 303, 579, 310, 586 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 485, 561, 552, 568 Flags: Print Annotation: Subtype: Link Rect: 315, 552, 363, 559 Flags: Print Annotation: Subtype: Link Rect: 303, 543, 310, 550 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 315, 524, 484, 531 Flags: Print Annotation: Subtype: Link Rect: 303, 515, 310, 522 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 359, 497, 484, 504 Flags: Print Annotation: Subtype: Link Rect: 303, 488, 310, 495 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 504, 478, 552, 485 Flags: Print Annotation: Subtype: Link Rect: 315, 469, 391, 476 Flags: Print Annotation: Subtype: Link Rect: 303, 460, 310, 467 Flags: Print Destination: 70 Annotation: Subtype: Link Rect: 387, 432, 500, 439 Flags: Print Annotation: Subtype: Link Rect: 303, 423, 310, 430 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 458, 405, 552, 412 Flags: Print Annotation: Subtype: Link Rect: 315, 396, 333, 403 Flags: Print Annotation: Subtype: Link Rect: 303, 387, 310, 394 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 512, 368, 552, 375 Flags: Print Annotation: Subtype: Link Rect: 315, 359, 387, 366 Flags: Print Annotation: Subtype: Link Rect: 303, 350, 310, 357 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 377, 322, 488, 329 Flags: Print Annotation: Subtype: Link Rect: 303, 313, 310, 320 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 387, 295, 500, 302 Flags: Print Annotation: Subtype: Link Rect: 303, 286, 310, 293 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 415, 248, 528, 256 Flags: Print Annotation: Subtype: Link Rect: 544, 248, 552, 256 Flags: Print Annotation: Subtype: Link Rect: 315, 239, 398, 246 Flags: Print Annotation: Subtype: Link Rect: 303, 230, 310, 237 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 504, 221, 552, 228 Flags: Print Annotation: Subtype: Link Rect: 315, 212, 399, 219 Flags: Print Annotation: Subtype: Link Rect: 303, 203, 310, 210 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 431, 184, 552, 191 Flags: Print Annotation: Subtype: Link Rect: 315, 175, 346, 182 Flags: Print Annotation: Subtype: Link Rect: 303, 166, 310, 173 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 476, 147, 552, 154 Flags: Print Annotation: Subtype: Link Rect: 315, 138, 349, 145 Flags: Print Annotation: Subtype: Link Rect: 303, 129, 310, 136 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 391, 101, 503, 108 Flags: Print Annotation: Subtype: Link Rect: 303, 92, 310, 99 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 367, 74, 479, 81 Flags: Print Annotation: Subtype: Link Rect: 303, 65, 310, 72 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 512, 56, 552, 63 Flags: Print Annotation: Subtype: Link Rect: 315, 46, 384, 53 Flags: Print Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 42, 726, 49, 733 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 53, 708, 173, 715 Flags: Print Annotation: Subtype: Link Rect: 42, 699, 49, 706 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 213, 681, 291, 688 Flags: Print Annotation: Subtype: Link Rect: 53, 672, 75, 679 Flags: Print Annotation: Subtype: Link Rect: 42, 663, 49, 670 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 173, 645, 287, 652 Flags: Print Annotation: Subtype: Link Rect: 42, 636, 49, 643 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 53, 618, 165, 625 Flags: Print Annotation: Subtype: Link Rect: 42, 609, 49, 616 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 369, 708, 501, 715 Flags: Print Annotation: Subtype: Link Rect: 309, 699, 316, 706 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 361, 681, 504, 688 Flags: Print Annotation: Subtype: Link Rect: 309, 672, 316, 679 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 426, 654, 558, 661 Flags: Print Annotation: Subtype: Link Rect: 309, 645, 316, 652 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 344, 627, 455, 634 Flags: Print Annotation: Subtype: Link Rect: 309, 618, 316, 625 Flags: Print Destination: 142 Annotation: Subtype: Link Rect: 437, 600, 558, 607 Flags: Print Checksum: 231c6421 Type: CRC32 Checksum: e3f044aed3affaed62013a769136fbb8 Type: MD5 Checksum: cbda990fa4229c9c136c2e54ae4b38dedb772911 Type: SHA-1 Checksum: 4ca0c83cdab11ca296e2d5fab7abc95bd2d9e95a9311577b88023b28760d35ba Type: SHA-256