CINXE.COM

<!DOCTYPE html><html lang="en-US"><head><title>Just a moment...</title><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge"><meta name="robots" content="noindex,nofollow"><meta name="viewport" content="width=device-width,initial-scale=1"><style>*{box-sizing:border-box;margin:0;padding:0}html{line-height:1.15;-webkit-text-size-adjust:100%;color:#313131;font-family:system-ui,-apple-system,BlinkMacSystemFont,Segoe UI,Roboto,Helvetica Neue,Arial,Noto Sans,sans-serif,Apple Color Emoji,Segoe UI Emoji,Segoe UI Symbol,Noto Color Emoji}body{display:flex;flex-direction:column;height:100vh;min-height:100vh}.main-content{margin:8rem auto;max-width:60rem;padding-left:1.5rem}@media (width <= 720px){.main-content{margin-top:4rem}}.h2{font-size:1.5rem;font-weight:500;line-height:2.25rem}@media (width <= 720px){.h2{font-size:1.25rem;line-height:1.5rem}}#challenge-error-text{background-image:url(data:image/svg+xml;base64,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);background-repeat:no-repeat;background-size:contain;padding-left:34px}@media (prefers-color-scheme:dark){body{background-color:#222;color:#d9d9d9}}</style><meta http-equiv="refresh" content="390"></head><body class="no-js"><div class="main-wrapper" role="main"><div class="main-content"><noscript><div class="h2"><span id="challenge-error-text">Enable JavaScript and cookies to continue</span></div></noscript></div></div><script>(function(){window._cf_chl_opt={cvId: '3',cZone: "www.ahajournals.org",cType: 'managed',cRay: '8e7672d5fe59a11c',cH: 'tTudS4JO_vrosoKb9Q0z705.uf0F.YCloRbgLFO4wAc-1732420370-1.2.1.1-6yjm8HKLBngAekpepZh077U3T.hsqqVZp06LDOb7FrxXEjn3K.9ZViCCGbUTMBey',cUPMDTk: "\/doi\/pdf\/10.1161\/01.CIR.0000080326.15367.0C?__cf_chl_tk=ZMzv0Z1YsYY7cwsh8eAqzfMcpROBKYAUAf4LzUShHXg-1732420370-1.0.1.1-mMK9IPi53sOvR6bj2IJER0DhKi1drc2Is8eqpm5Q7Pw",cFPWv: 'g',cITimeS: '1732420370',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "",fa: "\/doi\/pdf\/10.1161\/01.CIR.0000080326.15367.0C?__cf_chl_f_tk=ZMzv0Z1YsYY7cwsh8eAqzfMcpROBKYAUAf4LzUShHXg-1732420370-1.0.1.1-mMK9IPi53sOvR6bj2IJER0DhKi1drc2Is8eqpm5Q7Pw",md: "R7Y.j29da_LF1f.gYILRnEOxnrfT3GkYcE7zgProIlk-1732420370-1.2.1.1-ebvUlYpxkvfTfigxEdcAmTHCV4.frSMw_LYxNEyOtlnCRUhYIaJT0iIknzHLcFTeaVXOl4p8mqdZyhal5sIJDUha.1I71ZVLGszbAtAj8UpuJVeaYi1UmTp8Tnktgzu_Q.KiqefI7pk1eINkxkqh9V2tfxLriZ2BXbx211ds0COy1XeTe7nQFb8ykd6yz97E7cnOUnH80HgfZBMz2qUGB55LpGPlP6MrNcNfXr5Clt.rsZaaWNeUJEpL2_oCaqjKNS7e0DNCI7brnNR6BLwd05iR.jbtf7AI7hxEicnoflVJ.b55M4WCFrf6ZJGVe2vm21qEJf9sN.sPmkMRcSPGt3xDpTp6avI8oluWODrt_dlW9wNitjnjRWMl6aYHwRBnr2uAZN5NZGFzbimD.i968.I1l2Bac2iI5SPIjSG9dppu19qdb43LM7aTQxzQdOwqKTO2m19r0NfWn97NnuPyfjL3z_00LT8282aCMgU_cxq3krNw57TlS3VZgXGRbW7Mr1ye1MwH0kwhb5OJxC7qJ5KfqElQ8Marrk0udBI5iuQbd2.0qWGo8_pVM16_5SkDKFQXFIsR42qm_Au8aVidKzP4qrlPVsWJ6hd.O._HlYiMCRttx2u1IkhHBpLB.FJcE_OJLq2639Syxrk.opBvFuHC_K3MriAcNVWVwBtL.2NgEITot8ER3RMef9P9gyNpFqTLDfXCvzrgoRaImkFS_N6vNverwL4xTnRRC3844W1wmAL0CGEMVMzBnJ2cDfec6nCA25DQx9RseTwlPiG7UAn4SBvzr.gTIE68LPT2YtRYQuuoiSkqL2NhNGJde0q_CGSBP4.TJEjqKl5RA_b5sYtABvLDhVkgual8e7wJmmZhgqVz0UG_DpMP6ENSX4MpZUZZwcEvdg.CpxanaiKFVCs2Z.idEvkXJf78uADpsBvqg98.4DtY8h926lEHlNzOK7xD.tdzsRtNhcHZp6zu7uGNfX1Xvz9GbXd_Ndch9TOMf55WXLpQd98XjfCdtaNlrwtmORoYJDN1SkuAb9e0peEuK8UWDFuwEG05lpWdQS4jiqNFylOGcHMpgXnNAnNMWjhhnUpIQRRWbRTX86TWahxtO97AOWOYwSXZtB3H2AYmbBR50m48_J0cyT0bLWP_vFK5XgXrcoYKM1LMbQbdaBONkh2htLzV4fligJz_ZXSM4Cu5M6qzvsW9SvYq6yFV_dil.TTFsagtEA6MjTVqn_QZfzUqJae2ya1eW9JkO_6oTlYbzEb_Gqx7PFS6EPTFRYDB085tDTO7fP5t3V56_vDW1StEQBgbBOAmT_nXsOSxgGrB1wHH4pf3whii6taCq92Gkj2Ix989ZNuhnEK7GHd4rBOkLdZZB2Z0OrCUu9y8euqN7EndDl7mQOOZo2Qe40HX096yYEffCabM.0_QDZmizWtsIT2fMQTgnsdq.aQAXbhDP2Vwn7kdaEoRIrm_oj263Nim6bf_9XGMVypaLjt_4HgMEFe3GQBaRv.mw8fOEPkGQVYruSKjb_jhN.o_uzn61HXaaO2zSEl2hqFnYKWl8R46AsCTz.WUKTlw38FqDMlL5DYaE4kvHHPM6.m5DsWOKkRKyTDwFU_mf0Z6E3rcx1VH355Hm32QVT3m43jZU7.8FLgKCMoKBAzc.buI3ccU.i4CqR8IVVLZGS79xPp3QZEYwv8rUFMdlJxCwyaG4n.JcNT3AXMkWcF5NQObZJoYrd6wBf_Wuflo1UPMbKTdzdHQJES.C8smKJI8scAHk69Fr_HhdVBAPKYEtTYXKjqczp7XM0CXGKjwPIp5aoftzXeZ.jl4EFR5pJZ8iVGH4_Vcwb9bVo0velH5fvSbYs55Tie2L.ey9mtExYG1UzSwxnmXlztQAvYWsWROfaM5z19ZiXTMx6iU49AUCFD41EYNybmXtM0p6RiG5RXN2PYd79FfjkxDeR2aSWx8EuKSIYqDSlJcrAmn8xr.iJHP2vYATS0ofS1Z1_LmE7heWnnRHaKc.h3cCrIxxHQoM7ht9I8zDqqvoVloFd160vCw7ftuYBfwfxmZskrLePlrfhmzE8E3y6KxNZ7nnhAaBJtPYAARD.SF2zlMQuPIR91vdebdUyT7EjA141BWfpwwUpg21Efdn69AxhQ9pV_qqvRqZ5bge6Glxepn4uZegXqSvlLBSwjl.r2CTB5e2QRtsd_dUToDwRA8aJireawbFNjCo9WUFGK3KjshpCa7hAUd6a4OOmqvmYpHO1ClxJ3UAuURm5sjcpaJofGfolaM0RWwBQWvMe.Gusxe.kN3TRGO1VwHXAu1GnQPzxLXPcD.PLSDRLjk1By7zN_lwgLvjQHxTMjO9OlZBIhtkMeV0FAHyccftK0cge3FhUDXLLUFJBUg8K2lX4L_cV8rhecxrshckWj6FhAHwQTBFOHYZ3WN1o8Eic8.xykAtdh8KJGZq92zP.tH0avv9d4gqi391a.bvi_NKGGuMxxpGpzgHj6R9LD7lBC0kMwiH3D2NRcoviVaRfAXt.T9H5Jt4UEg5N4Ojv1j_6LK9bEjEA0ihBaB844vkoUbFF_VELIXfie5BCJGobozYHIS0BI9vpPXgAYD6loAtFRxZegXHgqewIwxXY4i3ovJ_B8qv609cRqbkp6sBRaCJJpxdsJwxG2.uRcAiUgIIQM_pjX_bYOleqIrSvIhpjaJjSKIL39tq7NGjSOoRjq5LRNEC4MIE7ZuNjU9Kei6p3I360vBRTLAUrGG5UeUVAU2FzJqIInYtF.hmBsqK2rJm4C8Kbn7JhPbmw74aKcABLlJK.QlbYrQER9fXBGMHh2kvTWaVOzhgX6YmJ6VFO0H0c8avAxWQ2g3KPcUiY3OoNGhLvnMfmDLYBukU1IAm0bqLu6lW8bL5GUPZFD172j8epwTEk_HUJmiJay9gv6BBqZzygYCnrK1HLC5iTcXSR3Z2Lo8yf6mE0SfumQ2Q112mvLa_ywhwb5oRNRuQXvMlzKZkwCK0qU7lbxegQ81m5gop7KiRUVV_N2lQw",mdrd: "Roco9ALndvLuBUavi1Sp1b4KB3s4c39Mzqyfgg.50vg-1732420370-1.2.1.1-5cy3F9HwqVQo1vuz1DvnjkgPAyvu3aEGn36eGWYeOHhPzvpnhlP1XEJ5Eym02kah2fQjnhToyAhc1SvNEWjMwzsXvxT3o1m3t3.6tOw8fctlVthPc7BjPyHB6fK1aPKMc5bZNoMkMfpb03OIgwrtlXqWKap6vSrdLyrryhmELJEBKKYIn3D40zSng6uRZFBKv4WM0LkqX405IyuiGdNq017zNwqq3xLXHjPpCbzsdohz29RcquDnlIPAaChPhJs8zcc2.RZMjWQQxvbdNMsVDQhLpn16E7Ao17wsi4NiwCtfW0r7MKsmyZCl.GynUrBu0ofusir7fwObsQ5CuM1bX_Rgp65dw8mAT7eXqZOlwAZaN2GoOFdRD.4FRf.mcmgn_CEWwr6Rp5BI9rnILLfko6QXzIkUYDk3mKOekoJoqRoGSvUDh_ZisMJPy0qeNR2ft16jvrlxdIzNkkCnSjg520Ne2ALwwtv2ASiZWan5YJcb9rYvUIF5sWTK8twftfySiAmr8U8zeTMz9pUq8LzplebDi6.lC1aezZUyzT5_ACaxIyoq5.oea8nr2NtzPRmS..Ic9oUazmrD5VGVAOcjM8uqs4GBB2uvC.kbEgNbUofaiun8MmV_Xku0FiVLc0I2SbKJ_7ngAvTax2be.Owxf6jbjxVSVk2tXcAlmM7zJ4UHmb_pkgJ2nO32dM0XKlLPtwDOxz_C.4atG9m6q7uoGWrpEAx4jH4hYli921QYygUlsT5gt3nlxaXQsqIqwkF10QeIQ01reITCs8YAHFXkJO.KZRuTZUktApUjreaXvP9TcX3utnrKOdYx5A_Um5Pz3OywjctkCNtje.B2VLOQuOpCKNos_c.aXFq6Dlt_yByqFXl55zlH6faODrWCRZPuv4tY53XCGfFPaBXMyZWGEHFj2ZeAGbqlopGeQJbL4MU44fWGAAR8wYEWsmSOhY0iEKbEzTG69dmr.R4.ESgMPQesizvL5MJaK47hjF3KTrMhCTQmGO3LTl_UI4bHnyUr21gbJ2.V9pMIwv_kfYnf.fZ28wvBhAP2pyefVa2qDJnJxzimNIUmjvy4HxSQnFSXoMmB6z5v.NNR7z.C6wOmidR3qdi.6gTAeevGM23CPxDK34CU4QqdVfhE3psSkc6uQjZtbykZ.2MXrb.TCMOEMPutFRKSqza17NZd3jl88kBG3KrCGQL1I4Z0MBTk3O84B5b3aVJ1yM7hobcvG0khqpPmN7C.iC84a32QG8Vnz4vEZORKP8X9twg7J5nw1NZk40b.Rh7kXw0QwqMAbc1GoCW8_lM3jPPyboDAGfrlzlgkcuYRL7ilxR_SjUOlhv3wDp5EFQ3J5_E43mP4ZvA43CYS5sJctdW7GDHBmOqzmtweum5VF87A4r8ocvV1TwNGKmip94Y4RCZUCrZNNkX400k0fZ4T8s2GYmEtPyvxtmyiTkeObTqipi0Si.OvPdV1e57x16SIf3VApw1D_36e7.PjnMaIeUaQi.a2Ixyi5IbXu1ps3KnC8nF0hE0NpaLePGppIORHFrWsZQ.O4lCpmH0A36g5LD8j6TTTCOgLHNh.ylXDCcD_17O.quhHl5Hm0UBtdO2SlM4Hm7spg7rMsd9Qi0aoXwI6qZFBcysa6aAHSu.z94Q5URFvU4CDggkrID0JHRYfuqK1rytC.BcuFRacEFWuNq4_G.KmBOD.w.KhlBKwNXhRR1M2hwYwm50r_mjZmWkRXkzG47D6JzI9fLdCmt9l5auutLgv.3V4QA706TLJ747JMBEinfpdcX84IjzcuRpDLTz9IH_eTdgjRTbiqVmRxqxlgR8WMkjVKO8.XF5ng1sLI_cLukT_vLh6ahSjP05CdGSGveQGzfcSQLLLeyKSHtrhSAbKNTux1ZZI.EO0uSHHq0_UpY5EU5sI5gAsdyDfwm3c8DUXtpxUCL34SbG7dnwxEVZYbDuUTNEMFm4ajYkrnnK25hPRTPuz"};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/g/orchestrate/chl_page/v1?ray=8e7672d5fe59a11c';window._cf_chl_opt.cOgUHash = location.hash === '' && location.href.indexOf('#') !== -1 ? '#' : location.hash;window._cf_chl_opt.cOgUQuery = location.search === '' && location.href.slice(0, location.href.length - window._cf_chl_opt.cOgUHash.length).indexOf('?') !== -1 ? '?' : location.search;if (window.history && window.history.replaceState) {var ogU = location.pathname + window._cf_chl_opt.cOgUQuery + window._cf_chl_opt.cOgUHash;history.replaceState(null, null, "\/doi\/pdf\/10.1161\/01.CIR.0000080326.15367.0C?__cf_chl_rt_tk=ZMzv0Z1YsYY7cwsh8eAqzfMcpROBKYAUAf4LzUShHXg-1732420370-1.0.1.1-mMK9IPi53sOvR6bj2IJER0DhKi1drc2Is8eqpm5Q7Pw" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>