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Kelham M, Beirne AM, Rathod KS, Andiapen M, Wynne L, Ramaseshan R, Learoyd AE, Forooghi N, Moon JC, Davies C, Bourantas CV, Baumbach A, Manisty C, Wragg A, Ahluwalia A, Pugliese F, Mathur A, Jones DA. The effect of CTCA guided selective invasive graft assessment on coronary angiographic parameters and outcomes: Insights from the BYPASS-CTCA trial. J Cardiovasc Comput Tomogr 2024; 18:291-296. [PMID: 38462389 DOI: 10.1016/j.jcct.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Computed tomography cardiac angiography (CTCA) is recommended for the evaluation of patients with prior coronary artery bypass graft (CABG) surgery. The BYPASS-CTCA study demonstrated that CTCA prior to invasive coronary angiography (ICA) in CABG patients leads to significant reductions in procedure time and contrast-induced nephropathy (CIN), alongside improved patient satisfaction. However, whether CTCA information was used to facilitate selective graft cannulation at ICA was not protocol mandated. In this post-hoc analysis we investigated the influence of CTCA facilitated selective graft assessment on angiographic parameters and study endpoints. METHODS BYPASS-CTCA was a randomized controlled trial in which patients with previous CABG referred for ICA were randomized to undergo CTCA prior to ICA, or ICA alone. In this post-hoc analysis we assessed the impact of selective ICA (grafts not invasively cannulated based on the CTCA result) following CTCA versus non-selective ICA (imaging all grafts irrespective of CTCA findings). The primary endpoints were ICA procedural duration, incidence of CIN, and patient satisfaction post-ICA. Secondary endpoints included the incidence of procedural complications and 1-year major adverse cardiac events. RESULTS In the CTCA cohort (n = 343), 214 (62.4%) patients had selective coronary angiography performed, whereas 129 (37.6%) patients had non-selective ICA. Procedure times were significantly reduced in the selective CTCA + ICA group compared to the non-selective CTCA + ICA group (-5.82min, 95% CI -7.99 to -3.65, p < 0.001) along with reduction of CIN (1.5% vs 5.8%, OR 0.26, 95% CI 0.10 to 0.98). No difference was seen in patient satisfaction with the ICA, however procedural complications (0.9% vs 4.7%, OR 0.21, 95% CI 0.09-0.87) and 1-year major adverse cardiac events (13.1% vs 20.9%, HR 0.55, 95% CI 0.32-0.96) were significantly lower in the selective group. CONCLUSIONS In patients with prior CABG, CTCA guided selective angiographic assessment of bypass grafts is associated with improved procedural parameters, lower complication rates and better 12-month outcomes. Taken in addition to the main findings of the BYPASS-CTCA trial, these results suggest a synergistic approach between CTCA and ICA should be considered in this patient group. REGISTRATION ClinicalTrials.gov, NCT03736018.
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Affiliation(s)
- Matthew Kelham
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Anne-Marie Beirne
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Mervyn Andiapen
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Lucinda Wynne
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Rohini Ramaseshan
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Annastazia E Learoyd
- Barts Cardiovascular Clinical Trials Unit, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom
| | - Nasim Forooghi
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - James C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ceri Davies
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Christos V Bourantas
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Charlotte Manisty
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andrew Wragg
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Barts Cardiovascular Clinical Trials Unit, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom
| | - Francesca Pugliese
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Barts Cardiovascular Clinical Trials Unit, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom.
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Jones DA, Beirne AM, Kelham M, Rathod KS, Andiapen M, Wynne L, Godec T, Forooghi N, Ramaseshan R, Moon JC, Davies C, Bourantas CV, Baumbach A, Manisty C, Wragg A, Ahluwalia A, Pugliese F, Mathur A. Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial. Circulation 2023; 148:1371-1380. [PMID: 37772419 PMCID: PMC11139242 DOI: 10.1161/circulationaha.123.064465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac angiography (CTCA) may facilitate ICA in this group, but this has not been tested in a randomized controlled trial. METHODS This study was a single-center, open-label randomized controlled trial assessing the benefit of adjunctive CTCA in patients with previous coronary artery bypass grafting referred for ICA. Patients were randomized 1:1 to undergo CTCA before ICA or ICA alone. The co-primary end points were procedural duration of the ICA (defined as the interval between local anesthesia administration for obtaining vascular access and removal of the last catheter), patient satisfaction after ICA using a validated questionnaire, and the incidence of contrast-induced nephropathy. Linear regression was used for procedural duration and patient satisfaction score; contrast-induced nephropathy was analyzed using logistic regression. We applied the Bonferroni correction, with P<0.017 considered significant and 98.33% CIs presented. Secondary end points included incidence of procedural complications and 1-year major adverse cardiac events. RESULTS Over 3 years, 688 patients were randomized with a median follow-up of 1.0 years. The mean age was 69.8±10.4 years, 108 (15.7%) were women, 402 (58.4%) were White, and there was a high burden of comorbidity (85.3% hypertension and 53.8% diabetes). The median time from coronary artery bypass grafting to angiography was 12.0 years, and there were a median of 3 (interquartile range, 2 to 3) grafts per participant. Procedure duration of the ICA was significantly shorter in the CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus ICA alone, 39.5±16.9 minutes [98.33% CI, -23.5 to -18.4]; P<0.001), alongside improved mean ICA satisfaction scores (1=very good to 5=very poor; -1.1 difference [98.33% CI, -1.2 to -0.9]; P<0.001), and reduced incidence of contrast-induced nephropathy (3.4% versus 27.9%; odds ratio, 0.09 [98.33% CI, 0.04-0.2]; P<0.001). Procedural complications (2.3% versus 10.8%; odds ratio, 0.2 [95% CI, 0.1-0.4]; P<0.001) and 1-year major adverse cardiac events (16.0% versus 29.4%; hazard ratio, 0.4 [95% CI, 0.3-0.6]; P<0.001) were also lower in the CTCA+ICA group. CONCLUSIONS For patients with previous coronary artery bypass grafting, CTCA before ICA leads to reductions in procedure time and contrast-induced nephropathy, with improved patient satisfaction. CTCA before ICA should be considered in this group of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03736018.
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Affiliation(s)
- Daniel A. Jones
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anne-Marie Beirne
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Matthew Kelham
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Krishnaraj S. Rathod
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mervyn Andiapen
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Lucinda Wynne
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Thomas Godec
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Nasim Forooghi
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Rohini Ramaseshan
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - James C. Moon
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ceri Davies
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Christos V. Bourantas
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Charlotte Manisty
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andrew Wragg
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Francesca Pugliese
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
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