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The authors logically suggest that the data, taken in the context of promising clinical results from this and other angiogram-derived physiology systems, indicate that vFFR should be used more routinely in clinical practice to improve the precision of patient diagnosis and management. The paper indeed highlights the considerable clinical potential of angiogram-derived physiology systems. Reassuringly, the degree of reclassification of vessels with significant disease and overall change in management reported in VIRTU4 are remarkably similar to the results of RIPCORD (Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?),2 on which this methodology was based, and several other studies that employed intracoronary pressure wire assessment of all coronary arteries of a size consistent with revascularisation and compared outcomes with angiographic assessment alone.3 The vFFR results certainly therefore raise the possibility that such profound alterations in diagnosis and management could be …" /> <meta name="DC.Contributor" content="Nick Curzen" /> <meta name="article:published_time" content="2024-08-01" /> <meta name="article:section" content="Editorial" /> <meta name="citation_title" content="Angiogram-derived physiology: will it change the game or miss the boat?" /> <meta name="citation_journal_title" content="Heart" /> <meta name="citation_publisher" content="BMJ Publishing Group Ltd and British Cardiovascular Society" /> <meta name="citation_publication_date" content="2024/08/01" /> <meta name="citation_mjid" content="heartjnl;110/16/1020" /> <meta name="citation_id" content="110/16/1020" /> <meta name="citation_public_url" content="https://heart.bmj.com/content/110/16/1020" /> <meta name="citation_abstract_html_url" content="https://heart.bmj.com/content/110/16/1020.abstract" /> <meta name="citation_full_html_url" content="https://heart.bmj.com/content/110/16/1020.full" /> <meta name="citation_pdf_url" content="https://heart.bmj.com/content/heartjnl/110/16/1020.full.pdf" /> <meta name="citation_issn" content="1355-6037" /> <meta name="citation_issn" content="1468-201X" /> <meta name="citation_journal_abbrev" content="Heart" /> <meta name="citation_doi" content="10.1136/heartjnl-2024-324143" /> <meta name="citation_pmid" content="38955393" /> <meta name="citation_volume" content="110" /> <meta name="citation_issue" content="16" /> <meta name="citation_article_type" content="Editorial" /> <meta name="citation_section" content="Editorial" /> <meta name="citation_firstpage" content="1020" /> <meta name="citation_lastpage" content="1021" /> <meta name="citation_author" content="Nick Curzen" /> <meta name="citation_author_institution" content="Coronary & Structural Heart Research Group" /> <meta name="citation_author_institution" content="University Hospital Southampton NHS Foundation Trust" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-9651-7829" /> <meta name="citation_reference" content="citation_journal_title=Heart;citation_journal_abbrev=Heart;citation_author=M. Ghobrial;citation_author=H. Haley;citation_author=R. Gosling;citation_title=Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4);citation_pages=1048-1055;citation_volume=110;citation_year=2024;citation_issue=16;citation_pmid=38754969;citation_doi=10.1136/heartjnl-2024-324039" /> <meta name="citation_reference" content="citation_journal_title=Circ Cardiovasc Interv;citation_author=N. Curzen;citation_author=O. Rana;citation_author=Z. Nicholas;citation_title=Does routine pressure wire assessment influence management Strat- Egy at coronary angiography for diagnosis of chest pain?: The RIPCORD study;citation_volume=7;citation_year=2014;citation_pmid=24642999;citation_doi=10.1161/CIRCINTERVENTIONS.113.000978" /> <meta name="citation_reference" content="citation_journal_title=Cardiovasc Revasc Med;citation_author=V. Nagaraja;citation_author=M. Mamas;citation_author=M. 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Gilpin;citation_title=Fractional flow reserve derived from coronary computed tomography: where are we now and where are we heading;citation_pages=723-41;citation_volume=17;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=Circulation;citation_author=RH. Stables;citation_author=LJ. Mullen;citation_author=M. Elguindy;citation_title=Routine pressure wire assessment versus conventional angiography in the management of patients with coronary artery disease: the RIPCORD 2 trial;citation_pages=687-98;citation_volume=146;citation_year=2022;citation_doi=10.1161/CIRCULATIONAHA.121.057793" /> <meta name="citation_reference" content="citation_journal_title=Cardiovasc Res;citation_author=N. Curzen;citation_title=Fame3: good science, bad reception?;citation_pages=e103-4;citation_volume=118;citation_year=2022" /> <meta name="twitter:title" content="Angiogram-derived physiology: will it change the game or miss the boat?" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://heart.bmj.com/sites/default/files/highwire/heartjnl/110/16.cover-source.jpg" /> <meta name="twitter:description" content="Ghobrial et al describe the impact that one coronary angiogram-derived physiology system, virtual fractional flow reserve (vFFR), has on diagnosis and decision-making of cardiologists when assessing patients undergoing diagnostic angiography for either chronic coronary syndrome or non-ST elevation (NSTE) myocardial infarction (MI), when compared with angiography alone.1 In 320 patients, the availability of vFFR data led to a significant reduction in the number of vessels considered to have important disease and changed the management in 22% of cases when compared with their classification using angiography alone. The authors logically suggest that the data, taken in the context of promising clinical results from this and other angiogram-derived physiology systems, indicate that vFFR should be used more routinely in clinical practice to improve the precision of patient diagnosis and management. The paper indeed highlights the considerable clinical potential of angiogram-derived physiology systems. Reassuringly, the degree of reclassification of vessels with significant disease and overall change in management reported in VIRTU4 are remarkably similar to the results of RIPCORD (Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?),2 on which this methodology was based, and several other studies that employed intracoronary pressure wire assessment of all coronary arteries of a size consistent with revascularisation and compared outcomes with angiographic assessment alone.3 The vFFR results certainly therefore raise the possibility that such profound alterations in diagnosis and management could be …" /> <meta name="og-title" property="og:title" content="Angiogram-derived physiology: will it change the game or miss the boat?" /> <meta name="og-url" property="og:url" content="https://heart.bmj.com/content/110/16/1020" /> <meta name="og-site-name" property="og:site_name" content="Heart" /> <meta name="og-description" property="og:description" content="Ghobrial et al describe the impact that one coronary angiogram-derived physiology system, virtual fractional flow reserve (vFFR), has on diagnosis and decision-making of cardiologists when assessing patients undergoing diagnostic angiography for either chronic coronary syndrome or non-ST elevation (NSTE) myocardial infarction (MI), when compared with angiography alone.1 In 320 patients, the availability of vFFR data led to a significant reduction in the number of vessels considered to have important disease and changed the management in 22% of cases when compared with their classification using angiography alone. The authors logically suggest that the data, taken in the context of promising clinical results from this and other angiogram-derived physiology systems, indicate that vFFR should be used more routinely in clinical practice to improve the precision of patient diagnosis and management. The paper indeed highlights the considerable clinical potential of angiogram-derived physiology systems. Reassuringly, the degree of reclassification of vessels with significant disease and overall change in management reported in VIRTU4 are remarkably similar to the results of RIPCORD (Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?),2 on which this methodology was based, and several other studies that employed intracoronary pressure wire assessment of all coronary arteries of a size consistent with revascularisation and compared outcomes with angiographic assessment alone.3 The vFFR results certainly therefore raise the possibility that such profound alterations in diagnosis and management could be …" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://heart.bmj.com/sites/default/files/highwire/heartjnl/110/16.cover-source.jpg" /> <title>Angiogram-derived physiology: will it change the game or miss the boat? | Heart</title> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__7_nvR5_1lGDWTTI3czv9WIuWQtfhWBVbtjZlpTSvpNw__xUSLd2Ma72V6TZnlis3CmKtirol7SI-M3tHOtq4-H9M__l-qqkUBsnnxyrFoQ0F4e2pT2jUHEQPy0YWBLTPDoimU.css" media="all" />  <script src="https://cookie-cdn.cookiepro.com/scripttemplates/otSDKStub.js" type="text/javascript" charset="UTF-8" data-domain-script="565e50dd-f6e9-46d6-91cd-5c40a270264f"></script> <script type="text/javascript"> function OnetrustAdsConsent(){ if(googletag.apiReady){ //console.log("GoogleTag API ready") googletag.pubads().disableInitialLoad(); if(OptanonActiveGroups.match(/,4,/)){ googletag.pubads().setRequestNonPersonalizedAds(0); //googletag.pubads().refresh(); } else{ googletag.pubads().setRequestNonPersonalizedAds(1); googletag.pubads().refresh(); } } else{ OnetrustAdsConsent(); } } function OptanonWrapper() { OnetrustAdsConsent(); } </script>  <script type="text/javascript" src="/sites/default/files/advagg_js/js__DdxPgqGimsdUot2QWNz_pGsHzqNGpx6RMCWHpL8YWkg__c6zfK6oHHbLpTal5PdQxeQI3xGoCM8IXWtEHwIZr560__l-qqkUBsnnxyrFoQ0F4e2pT2jUHEQPy0YWBLTPDoimU.js"></script> <script type="text/javascript" src="https://securepubads.g.doubleclick.net/tag/js/gpt.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__RplUf5n1SHvT_MHHQProZaAaHxo7a_9YZuaKWYnqVeQ__t8vznsHJmtJcTuSP5JnWJ92mdmFUGaXxtxwBatvNwmc__l-qqkUBsnnxyrFoQ0F4e2pT2jUHEQPy0YWBLTPDoimU.js"></script> <script type="text/javascript" src="https://d1bxh8uas1mnw7.cloudfront.net/assets/embed.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__dNRQ0P3mzXReUF4250f2vTnR4K_GFl-M8oB_3K2j1fI__-eoy5F1B5hwy20bysxSQQrr2HBlAB7kgfK-OIh8VRRA__l-qqkUBsnnxyrFoQ0F4e2pT2jUHEQPy0YWBLTPDoimU.js"></script> <script type="text/javascript" defer="defer" async="async" src="//cdn.foxycart.com/bmjpg.ecommerce.highwire.org/loader.js"></script> <script type="text/javascript" async="async" src="https://scholar.google.com/scholar_js/casa.js"></script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script>   <script> let cookies = parseCookies(); let bmj_uuid = cookies.bmj_uuid; let bmj_ppid = cookies.bmj_ppid; window.dataLayer = window.dataLayer || []; const anonMailId = 'e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855'; function checkUserLoginStatus(dataLayer) { const userMail = dataLayer.find((item) => item.user)?.user?.mail; if (!userMail) { return false; } return userMail !== anonMailId; } let nonAnonMailId = ((dataLayer.find(item => item.user)?.user)?.mail) === anonMailId ? null : (dataLayer.find(item => item.user)?.user)?.mail; let userId = ((dataLayer.find(item => item.user)?.user)?.['data-ics']) ?? 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class="panel-separator"></div><div class="panel-pane pane-entity-field pane-node-field-highwire-article-cat article-category col-narrow-9 col-normal-10" > <div class="pane-content"> <div class="field field-name-field-highwire-article-cat field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Editorial</div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-citation col-mobile-10 col-narrow-10 col-normal-11 article-title" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node184709" data-node-nid="184709" id="node-184709--21476581338" data-pisa="heartjnl;110/16/1020" data-pisa-master="heartjnl;heartjnl-2024-324143" data-apath="/heartjnl/110/16/1020.atom"><cite class="highwire-cite highwire-cite-highwire-article highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">Angiogram-derived physiology: will it change the game or miss the boat?</div> <span class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="heartjnl;heartjnl-2024-324143" data-atom-uri="/heartjnl/110/16/1020.atom" data-request-view="full"></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_template_bmjj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://heart.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_template_bmjj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup author-affiliates col-narrow-12 author-affiliates-corresp article" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="last" id="contrib-1"><a href="http://orcid.org/0000-0001-9651-7829" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0001-9651-7829</a><span class="name">Nick Curzen</span><span class="xref-aff"></span></li></ol><ol class="affiliation-list"><li class="aff"><address> <span class="institution">Coronary & Structural Heart Research Group</span>, <span class="institution">University Hospital Southampton NHS Foundation Trust</span>, <span class="addr-line">Southampton</span>, <span class="addr-line">Hampshire</span>, UK </address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label">Correspondence to</span> Professor Nick Curzen, Coronary & Structural Heart Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK; <span class="em-link"><span class="em-addr">nick.curzen{at}uhs.nhs.uk</span></span> </li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-1" > <div class="pane-content"> <p><a href="https://doi.org/10.1136/heartjnl-2024-324143" target="_new">https://doi.org/10.1136/heartjnl-2024-324143</a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-altmetrics" > <h2 class="pane-title">Statistics from Altmetric.com</h2> <div class="pane-content"> <div data-badge-details="right" data-badge-type="medium-donut" data-doi="10.1136/heartjnl-2024-324143" data-hide-no-mentions="true" class="altmetric-embed"></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-jumplinks" > <div class="pane-content"> <div class="highwire-list-wrapper"><div class="highwire-list"><ul></ul></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-2 permissions-box" > <h2 class="pane-title">Request Permissions</h2> <div class="pane-content"> <p>If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.</p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-ajax-pane-content permissions-box pane-highwire-permission-link" id="request-permissions"> <h2 class="pane-title"><span class='panels-ajax-pane-title' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></span></h2> <div class="pane-content"> <div class='panels-ajax-pane panels-ajax-pane-new-70fd4c70-563e-4b94-ae3b-2a97f3980c13' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article extract-view"><span class="highwire-journal-article-marker-start"></span><ul class="kwd-group"><li class="kwd"><a href="/keyword/diagnostic-imaging" class="hw-term hw-article-keyword hw-article-keyword-diagnostic-imaging" rel="nofollow">Diagnostic Imaging</a></li><li class="kwd"><a href="/keyword/coronary-angiography" class="hw-term hw-article-keyword hw-article-keyword-coronary-angiography" rel="nofollow">Coronary Angiography</a></li></ul><p id="p-1">Ghobrial <em>et al</em> describe the impact that one coronary angiogram-derived physiology system, virtual fractional flow reserve (vFFR), has on diagnosis and decision-making of cardiologists when assessing patients undergoing diagnostic angiography for either chronic coronary syndrome or non-ST elevation (NSTE) myocardial infarction (MI), when compared with angiography alone.<span class="xref-bibr">1</span> In 320 patients, the availability of vFFR data led to a significant reduction in the number of vessels considered to have important disease and changed the management in 22% of cases when compared with their classification using angiography alone. The authors logically suggest that the data, taken in the context of promising clinical results from this and other angiogram-derived physiology systems, indicate that vFFR should be used more routinely in clinical practice to improve the precision of patient diagnosis and management.</p><p id="p-2">The paper indeed highlights the considerable clinical potential of angiogram-derived physiology systems. Reassuringly, the degree of reclassification of vessels with significant disease and overall change in management reported in VIRTU4 are remarkably similar to the results of RIPCORD (Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?),<span class="xref-bibr">2</span> on which this methodology was based, and several other studies that employed intracoronary pressure wire assessment of all coronary arteries of a size consistent with revascularisation and compared outcomes with angiographic assessment alone.<span class="xref-bibr">3</span> The vFFR results certainly therefore raise the possibility that such profound alterations in diagnosis and management could be … </p><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="https://heart.bmj.com/content/110/16/1020.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup footnotes" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-other" id="fn-1"><p id="p-6"><span class="fn-label">X</span> @ncurzen</p></li><li class="fn-other" id="fn-2"><p id="p-7"><span class="fn-label">Contributors</span> NC wrote this article and guarantees its content.</p></li><li class="fn-other" id="fn-3"><p id="p-8"><span class="fn-label">Funding</span> The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.</p></li><li class="fn-conflict" id="fn-4"><p id="p-9"><span class="fn-label">Competing interests</span> NC has received research funding from HeartFlow for FFRCT RIPCORD, FORECAST & FFS and has contributed to the PRECISE & PLATFORM studies. He is also recruiting to PIONEER & DEFINE GPS</p></li><li class="fn-other" id="fn-5"><p id="p-10"><span class="fn-label">Provenance and peer review</span> Commissioned; internally peer reviewed.</p></li></ul></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-dfp-pane" > <div class="pane-content"> <div id="dfp-ad-mpu-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-mpu" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-mpu"); }); </script> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-atom bmjj-linked-articles" id="linked-articles"> <h2 class="pane-title">Linked Articles</h2> <div class="pane-content"> <div class="highwire-atom-data-bmjj-linked-articles field field-highwire-atom-data field-label-hidden clearfix"><div class="field-items"><div class="highwire-list highwire-atom-data-list"><ul><li class="first last odd">Coronary artery disease<div class = "highwire-article-citation bmjj-article-citation"><div class="highwire-cite"><div class="highwire-cite-title"><a href="/content/110/16/1048" class="bmjj-linked-article" data-icon-position="" data-hide-link-title="0">Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4)</a></div> <div class = "highwire-cite-authors"><div class="highwire-citation-authors"><span class="highwire-citation-author">Mina Ghobrial</span> <span class="highwire-citation-author">Hazel Haley</span> <span class="highwire-citation-author">Rebecca Gosling</span> <span class="highwire-citation-author">Daniel James Taylor</span> <span class="highwire-citation-author">James Richardson</span> <span class="highwire-citation-author">Kenneth Morgan</span> <span class="highwire-citation-author">David Barmby</span> <span class="highwire-citation-author">Javaid Iqbal</span> <span class="highwire-citation-author">Arvindra Krishnamurthy</span> <span class="highwire-citation-author">Rajender Singh</span> <span class="highwire-citation-author">Dwayne Conway</span> <span class="highwire-citation-author">Ian Hall</span> <span class="highwire-citation-author">Zulfiquar Adam</span> <span class="highwire-citation-author">Nigel Wheeldon</span> <span class="highwire-citation-author">Ever D Grech</span> <span class="highwire-citation-author">Robert F Storey</span> <span class="highwire-citation-author">Alexander Rothman</span> <span class="highwire-citation-author">Gillian Payne</span> <span class="highwire-citation-author">Muhammad Naeem Tahir</span> <span class="highwire-citation-author">Simon Smith</span> <span class="highwire-citation-author">Justin Cooke</span> <span class="highwire-citation-author">Steven Hunter</span> <span class="highwire-citation-author">Neil Cartwright</span> <span class="highwire-citation-author">Syed Sadeque</span> <span class="highwire-citation-author">Norman Paul Briffa</span> <span class="highwire-citation-author">Abdallah Al-Mohammad</span> <span class="highwire-citation-author">Laurence O’Toole</span> <span class="highwire-citation-author">Dominic Rogers</span> <span class="highwire-citation-author">Patricia V Lawford</span> <span class="highwire-citation-author">David R Hose</span> <span class="highwire-citation-author">Julian Gunn</span> <span class="highwire-citation-author">Paul D Morris</span> </div></div><div class="highwire-cite-metadata bmjj-citation-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">Heart </span><span class="highwire-cite-metadata-year highwire-cite-metadata">2024; </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">110 </span><span class="highwire-cite-metadata-pages highwire-cite-metadata">1048-1055 </span><span class="highwire-cite-metadata-date highwire-cite-metadata"><span class="label"> Published Online First:</span> 16 May 2024. </span><span class="highwire-cite-metadata-doi 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