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Original Research Article
Open Access

Physiology of Angina and Its Alleviation With NitroglycerinClinical Perspective

Insights From Invasive Catheter Laboratory Measurements During Exercise

Kaleab N. Asrress, Rupert Williams, Timothy Lockie, Muhammed Z. Khawaja, Kalpa De Silva, Matthew Lumley, Tiffany Patterson, Satpal Arri, Sana Ihsan, Howard Ellis, Antoine Guilcher, Brian Clapp, Philip J. Chowienczyk, Sven Plein, Divaka Perera, Michael S. Marber, Simon R. Redwood
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https://doi.org/10.1161/CIRCULATIONAHA.116.025856
Circulation. 2017;136:24-34
Originally published May 3, 2017
Kaleab N. Asrress
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Rupert Williams
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Timothy Lockie
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Muhammed Z. Khawaja
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Kalpa De Silva
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Matthew Lumley
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Tiffany Patterson
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Satpal Arri
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Sana Ihsan
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Howard Ellis
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Antoine Guilcher
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Brian Clapp
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Philip J. Chowienczyk
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Sven Plein
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Divaka Perera
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Michael S. Marber
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Simon R. Redwood
From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
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Article Information

vol. 136 no. 1 24-34
DOI: 
https://doi.org/10.1161/CIRCULATIONAHA.116.025856
PubMed: 
28468975

Published By: 
American Heart Association, Inc.
Print ISSN: 
0009-7322
Online ISSN: 
1524-4539
History: 
  • Received October 9, 2016
  • Accepted April 26, 2017
  • Originally published May 3, 2017.

Article Versions

  • Previous Version (May 3, 2017).
  • You are viewing the most recent version of this article.
Copyright & Usage: 
© 2017 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.

Author Information

  1. Kaleab N. Asrress, PhD;
  2. Rupert Williams, PhD;
  3. Timothy Lockie, PhD;
  4. Muhammed Z. Khawaja, PhD;
  5. Kalpa De Silva, PhD;
  6. Matthew Lumley, PhD;
  7. Tiffany Patterson, MBBS;
  8. Satpal Arri, MBBS;
  9. Sana Ihsan, MBBS;
  10. Howard Ellis, MSc;
  11. Antoine Guilcher, PhD;
  12. Brian Clapp, PhD;
  13. Philip J. Chowienczyk, MD, PhD;
  14. Sven Plein, MD, PhD;
  15. Divaka Perera, MD;
  16. Michael S. Marber, PhD;
  17. Simon R. Redwood, MD
  1. From King’s College London British Heart Foundation Centre of Excellence, Rayne Institute, St. Thomas’ Hospital, London, United Kingdom (K.N.A., R.W., T.L., M.Z.K., K.D.S., M.L., T.P., S.A., H.E., D.P., M.S.M., S.R.R.); National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.N.A., M.S.M., S.R.R.); Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (K.N.A., K.D.S.); Kolling Institute, Northern Clinical School, University of Sydney, Australia (K.N.A.); Department of Clinical Pharmacology (A.G., P.J.C.) and Division of Imaging Sciences and Biomedical Engineering, Rayne Institute (S.I., S.P.), St Thomas’ Hospital, King’s College London, London, United Kingdom; Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom (B.C.); and Division of Cardiovascular and Neuronal Remodelling, University of Leeds, United Kingdom (S.P.).
  1. Correspondence to: Kaleab N. Asrress, PhD, British Heart Foundation Centre of Excellence, The Rayne Institute, St Thomas’ Hospital, King’s College London, Westminister Bridge Road, London SE1 7EH, UK. E-mail kaleab.asrress{at}sydney.edu.au
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    Physiology of Angina and Its Alleviation With NitroglycerinClinical Perspective
    Kaleab N. Asrress, Rupert Williams, Timothy Lockie, Muhammed Z. Khawaja, Kalpa De Silva, Matthew Lumley, Tiffany Patterson, Satpal Arri, Sana Ihsan, Howard Ellis, Antoine Guilcher, Brian Clapp, Philip J. Chowienczyk, Sven Plein, Divaka Perera, Michael S. Marber and Simon R. Redwood
    Circulation. 2017;136:24-34, originally published May 3, 2017
    https://doi.org/10.1161/CIRCULATIONAHA.116.025856

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    Circulation. 2017;136:24-34, originally published May 3, 2017
    https://doi.org/10.1161/CIRCULATIONAHA.116.025856
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