CINXE.COM

Just a moment...

<!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,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIzMiIgaGVpZ2h0PSIzMiIgZmlsbD0ibm9uZSI+PHBhdGggZmlsbD0iI0IyMEYwMyIgZD0iTTE2IDNhMTMgMTMgMCAxIDAgMTMgMTNBMTMuMDE1IDEzLjAxNSAwIDAgMCAxNiAzbTAgMjRhMTEgMTEgMCAxIDEgMTEtMTEgMTEuMDEgMTEuMDEgMCAwIDEtMTEgMTEiLz48cGF0aCBmaWxsPSIjQjIwRjAzIiBkPSJNMTcuMDM4IDE4LjYxNUgxNC44N0wxNC41NjMgOS41aDIuNzgzem0tMS4wODQgMS40MjdxLjY2IDAgMS4wNTcuMzg4LjQwNy4zODkuNDA3Ljk5NCAwIC41OTYtLjQwNy45ODQtLjM5Ny4zOS0xLjA1Ny4zODktLjY1IDAtMS4wNTYtLjM4OS0uMzk4LS4zODktLjM5OC0uOTg0IDAtLjU5Ny4zOTgtLjk4NS40MDYtLjM5NyAxLjA1Ni0uMzk3Ii8+PC9zdmc+);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: '912ee21a2b55408e',cH: 'T_dDOzqe8TGLEfqq_RZM7CkGP93W8bhCT2eceJud9iU-1739723017-1.2.1.1-MkZ_W_NY8TWXhAzy3g6QWHNnGPaB6na1qhm4HBZGVpRtaaiz3ciTKsA4ewOVKiE0',cUPMDTk: "\/doi\/10.1161\/01.CIR.103.24.2973?__cf_chl_tk=MVv3P0mmq7OZIRWJpwUNfkKxYhh.yjEhO4LhP6slotA-1739723017-1.0.1.1-RFsZpOdlprz5i2pgIhErrZUx0kpVpgQ3G3ec84IIQkg",cFPWv: 'b',cITimeS: '1739723017',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "",fa: "\/doi\/10.1161\/01.CIR.103.24.2973?__cf_chl_f_tk=MVv3P0mmq7OZIRWJpwUNfkKxYhh.yjEhO4LhP6slotA-1739723017-1.0.1.1-RFsZpOdlprz5i2pgIhErrZUx0kpVpgQ3G3ec84IIQkg",md: "KT2GErlizRWkHcp3Ot85rIDxNOZH13VmYhGbioGJzMA-1739723017-1.2.1.1-XmWCmVyjgADV_lafdk8Y24Ruhs4Jx0xHE9Pck0NJ4JhWRH9WczUL_PSaOaxPb0O8IH0n4lpKUzVPe9pYIc5vLn9f13NmUofRxUF4Qn4ffz.kx8jIFvxJgTY2UezxW77ntUDXEeepxLw3tBGIMy5lmNK9yx4lAKA.rvAubW6DH1JEVYU0qNsitV.3fecxf7cvXqdnvqComyqRXxxUh4l_uwqVL35aWxIm.TaMAD.KAAys.dKKiio8LYnmLwgDVJAzjRrBlj7MzMMA4rrNWF8_MJfLLVIxOmB.oaK9wZRsejM2iPNydcv9DgrzQizmkInp7vASDTFSG8OCew6QXhqVzWAJOpvVb5z1VUN7PjniLoKTBb4vbeMuFQyKXQ0UG2gPwop43QejWBaiTy1zWny9BpG5a7L1ZUx47XzcpRh15nFQeXVhVy4tLcKuf6qwfjKXBQdG3cqRI.LU.xiHZ1pDL6pHMHTmliwgOS4PePbVvUfQsgNfqp6Aq4bgVVZA4TOGyCjnP6mpPbVkrGYeqsReyCXyRGjh25ENt_zbFHgUweowKHgjRPdCje0FwA0yUPndr3QgjfqNoMgD176U.GSTf52fbbAE3T2Nuslhf.CTbw7_F4GqHR1XynawT4c1JbuVn6OGj_lALejyJeB7eSFvA4c5GVJnckRJ746WJJCu0dAHqU.Ijmg7spf0iOcFHdiammvnIjfPl.XxdjEURu1Nbdb_J3rsUggybXMEsBGgatmN6dN6zhanA3DWiGrzoNKk6W9AWIwA2X1BVpubTd22.fHnda2i7gi45q1dX9p2vX0wOoHiwg18OUyCCnK1hbDnTEdWL5g9GSibYxSbAwqMRWuGsLpr1bMQkzyMTowL3ZvSPxAbgliuXQXaJbRV9c58KAUJIDqhrtivHv5Mnw.qUIjLRpmJINz.B7zQx4EyZUcQwFMsD.eiv6wKdaejhd68mjieNH.AhW_HpP_yFLmF.oQ5Tuzqi0f7WAwzHLbiMQLUo02TZQMNvvSEmtbCPiFZB_gnVFXtRi_OEbIALMeUE6DDWvQ6cvUVFrm08.2_Wo66I6rauqB_UXlTd9R9j6JRSxqC0HkIR7wJmKBe5V8UetMBRNXgU2vshId7iXHT8KtB5VmRgNwRipQAnahqv3eVmB6VX92fOO4RJbR2PrpE2bolSe8PVeYw3pBqSwwOeDEa8cbgulAehmJ0BHilvsYfKl.FPilzJWEBBAT4NK.Iurd6x_M8cYBTkGLfFBU0bYMPQ57u9s1udRekZazllnrxxTgiSVysRX_6WHDtAl5.VvmcbPBcat9K_9gua2C6s7c1nbREoEu4hvGMA4IwNMUeeQZCABLc6z4Ezw1e6QtsMNaIFixj9bBfMQ8Wys5n6xfqmp2iBGR9hGut8eSBaGHKaR8uCLWYivjfKqT7pUVP8Ro4Ya9FACR6BE0MmxYMdoZsdLi1sgu1m_MjL.cuGROllP5BuShlNYuOrBGnWmiNZXnB2TlQ_2IdbftRlKQVxKfCFZLMFrfGreMbKOLo0sm62SLTcAqwSb9lqdnnaW7xN8jF4UMG.VE2X85VAIWYep9pgzNW2F4rXB.m.JHBscsRfm5Y2VnZqkuNmo_sh1Q8vUsJJkISN2TqOxYrnaKdzm3vKb_om.iR3J0o55hyCRkD.tdDwZ2ZjXFMWqc4z6dFP_1kTQZlNkBGuBOiEZeIQLZN_6kl44X0HmjBo2GlJnoqc9UqPSruTrG3REDtPCWYngomNyQ.hbkAFlU.jf4fv1tX_jF_vMqlrUskFk5oqXHialsdml8WUy.j9FMUgb5LXO5D.FTWJkKVPNjMfl_AlW5msBm1H6fkcuUV9FL.0Qv.eGP_vIHhjl7GOHKzXvqBmmLP2xaF7VaKtL_haj_fFOrE5p9ocTIEZfIcUW0Ao0RF8YFGUIXod00mQ8AJc4rpQc02AcKHcRVGHvatAw0_5m9MvB_JWnw4VjWlU98SxKIrbpZ2YLJ6KFl6NQ.OC57iCXcumADshmZxHDYNcqCiH4vpC.keSX1UV5lCpX4u2agMEovSfuHVXVu.hWiKXhAZjQtpdYwKaAopnAnn0nNDAAKkb2LP0ni0cCfDwlMy1o1MyYFvLxrIWH0trDzREIUKr_tbX6Q7GbUo8tLqqbekNpZTpd90NcfEHZrMHuIC7rZt81jjmXb.EsYOxn42QL9U13J66XRLdK9aFEXpJifCi4nMFzJGKneZl1P8LY7BcOVpoxIZzUVeH43.bmQSfuHUgWmsIHFgKi87I4IiifgIoyLjisf.EpW9HZssxy8nKVMfaN6regi20Eo7VtMy36P3G4HNY3DfG7.LOko8.uJXoVjz7DTpjaq6l54YQuHJPTMu_IkpkddU.jCr2KMuwpZpMQbKlM2ANx5bB7njrUtq_mXkb08MnmFM_lRzRAgvwEly16YXJVDVkThobi1EnANLJtXoxL_fU38tZSgyXr1dKvhRVYnNTU1uP1WABePBeKDV.ci.58WkT4XkKk0HtS7c3lOtHB3ofQAevhWoeHvaAh25H2o0PNZYrXmyEqzPElVVDsGTFjf_uMLOrx0NTogpR.O9DaHZmcjadHsO9JtgYg4",mdrd: "AMFXBVSwx1GDfnhSfxNfF8UHqYDu_aVYJYDla6QDUJ8-1739723017-1.2.1.1-Z8cTqjRBG_Z4y3_s8ZYWFDgkkDVfxwtYkHbh_qXU1YH2b_PJnqbSneRc_8w0elQ0xC9CzTbgg7xxWM0YApoVSoAG2iqVYoNZKi_nCkUQX3zGTab3WqB2qn8zyVaAcC0M.ZpJn554Ii3IHyDU5Kf22n2O9hP8itVyJ4yNqWtD3ko_hmkbdTKAkH6Mmnw3K3KCS6qMJMkDo8sV7i_MzQVqhn18cAvCKVrfFyS4ZEf9qQPUS77dtHA16Yk40lW87tmbGM1kvrvRrGYowOHPY4aA.PVIFFqWCx6ko.0hqVTLZnSRF1YFkGmi2OwQQWG7MZJCWRtmdsDJQ9xf9p9P3UjnUfwvQ6ce3RFw6AQc9YFkFKaNGE3jnJ8eoJQJjxDiPpiOVXJmDu1E08PL16dSKJu.QYvg.NcnK5f9eINqCRIMxI6Ko2OWdmDNQDkToa25aA3zt5eBhqJ_PmZwypO7BOoi9bwD2pAx89uHsEWqVuJZh6goAlQ6uIHlQL.cxG4MCdvK83sRyLmrFXzLD9yyZHj9zQ6XD2RGBMK9ggxz8v1Nhduw4I3ex5LfrJKQnCkQgjmhNp106MNfP2qFV_alFfxqa12HLpnTTvrXCt5Qb8sGq_Ncc7NQvcM9bZwNliA10yEXKfltS9c6yzWmV6tk._pn66CtH9yQY4O6grfLOE.XvObxvSbge4Dbh7ZazaxZp_OkLFZdOywAJ4.JhKDjR3PEfCuM1amPwbQwah7BeEkvtB.iBT2Eb1q75zjUAVP3aggxXnKRWl6alOFqjAnm.W.1TWUZv3Q3Xu_Ew1OocRgb6lnBEGSgUxH_IKzRqa4ti1sheqOWGpotgwNjy_sLqW1d2uMWfwRC6JxnKVU.xsSpX57Q7zdXzWd.OrVak10reOG0kOUWcKCHVK5IyGQsiU9PcrTgcxEU1t0uwmMsp3yL7w3osIm.AvNkbxiuJDoVnBur79nqwhYEY2ZMrMO_eEjeyGCbmmlgaq6tctVWDDbvDDbY0v45ycUa9lcvEeCAOQQsohOvCu5oEsx_U1_IR0okKx_dlP80hXGpSoJgn.2KR4MiKOk58xY9q4_IGRpRhSUEVgZ5JJa.2vZG7OSxkNwVrDYPU5YHJZpD1gyGT.X5nh5M33A73Xd0tXRwZMrYerYCTQSpGqFAd70vSaaDWgPmQYPkjEkbJg5hxMuAz5U1x2g2lritbhGTplaEgRt9E2a6f8tzjunDcx0YSJnv7pWCggLnHFP2xlaa1h0Q.MwLnusCgE5oPn7aK3tiaTomXICuhpvlCE4j2Xge3h8R.9YvWqpzFmhMAKq.mqtycfzhJ3fkKY7GtdqcL2WdtImsGHnCoUkjMU_FNYbgKU9k0mUHS41Z_AZ7F.KBPbxzsqdI4IS5qJUboqzEOdQB0p4ung47ECmg9XAq.rdT6FNXPTQ8yU0lBe6gbTJRgde2OkLHppmbwCn_rRYbWNHG_a5aJlq1KDwGAbzz24TS2TnziwdD9NSgEQpFnUF94f7.URxTCfYs7AGFS6NDpi9.19gokSK19RnvNhzTaSJkUTqsPMFvtPhXGNoIgNgsZxPwcDHRM0n.ObDi4X2F2UjAU8TfRrXlB.1gyUVAUY2lTpKB5ONh7_Cr5fUfhKt7avv1S6kcXNKecn41gSRiHkpxiM7UoNLFBmfxPYIlEphenginKOJ7KeilwAMx12PLKm0M0OCdXCK3QNkQX7PGxLzwGejJyYjoRB8ye2y0bg8sOqobbJMMZ9_JnbIoOA0BVy540MOb70rutA2M5vZnVJW1QYgd3AV1Lpxq95gUi.cMW1VrLE1jf1JNlmK26NuldaGoAAcF4X9CL7G7lW9mjB2ZtMJDzuEqDnHrongvPzxbyUQz.5rgcNvRSY3JoZWBfuKsoiebLB9hIOtYlSpcgIJl_0c4NhftnZp.XLjktt8yiW.IEuwXvdjDXvlw9QOoHd_HXeXcGU4P4lybr5f8tDZic3gBqKAT"};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/b/orchestrate/chl_page/v1?ray=912ee21a2b55408e';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\/10.1161\/01.CIR.103.24.2973?__cf_chl_rt_tk=MVv3P0mmq7OZIRWJpwUNfkKxYhh.yjEhO4LhP6slotA-1739723017-1.0.1.1-RFsZpOdlprz5i2pgIhErrZUx0kpVpgQ3G3ec84IIQkg" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>