Moving in for Renovations: An Innovative Solution for Replacing End-of-Life Capital Equipment. The Michael Garron Hospital-Sunnybrook Collaborative Catheterization Laboratory Project.

Replacement of an end-of-life cardiac catheterization laboratory ("cath lab") can pose a significant challenge to a hospital, particularly in single-cath-lab institutions. The disruption in patient care requires innovative approaches to minimize the inconvenience and ensure ongoing quality of care. We describe a unique approach whereby Michael Garron Hospital (MGH) "leased" a cath lab within Sunnybrook Health Sciences Centre for a 12-week period during a cath lab replacement project at MGH.

Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure: The PACT-HF Randomized Clinical Trial.

Importance: Health care services that support the hospital-to-home transition can improve outcomes in patients with heart failure (HF).

Objective: To test the effectiveness of the Patient-Centered Care Transitions in HF transitional care model in patients hospitalized for HF.

Design, Setting, And Participants: Stepped-wedge cluster randomized trial of 2494 adults hospitalized for HF across 10 hospitals in Ontario, Canada, from February 2015 to March 2016, with follow-up until November 2016.

Brugada syndrome unmasked by malaria-induced fever.

Brugada syndrome is typically an autosomal dominant genetic disorder with variable expression, characterized by three specific electrocardiogram (ECG) patterns. While Type I Brugada ECG pattern is used as a classic marker for the disease, it is generally masked from ECG except in special cases such as malaria-induced fever. This vignette highlights a unique clinical scenario that can lead to the unmasking of Brugada type 1 pattern.

Knowledge to action: Rationale and design of the Patient-Centered Care Transitions in Heart Failure (PACT-HF) stepped wedge cluster randomized trial.

Introduction: Heart Failure (HF) is a common cause of hospitalization in older adults. The transition from hospital to home is high-risk, and gaps in transitional care can increase the risk of re-hospitalization and death. Combining health care services supported by meta-analyses, we designed the PACT-HF transitional care model.

Assessment of the longitudinal changes in infarct heterogeneity post myocardial infarction.

Background: Infarct heterogeneity, as assessed by determination of the peri-infarct zone (PIZ) by cardiac magnetic resonance imaging, has been shown to be an independent predictor for the development of cardiac arrhythmias and mortality post myocardial infarction (MI). The temporal evolution of the PIZ post MI is currently unknown. Thus, the main objective of our study was to describe the temporal evolution of the PIZ over a 6 month time period in contemporarily managed ST elevation myocardial infarction (STEMI) patients.

Diabetes is an independent predictor of right ventricular dysfunction post ST-elevation myocardial infarction.

Background: Diabetes mellitus (DM) is estimated to become the 7th leading cause of death by 2030. Right ventricular dysfunction (RVD) complicating ST elevation myocardial infarction (STEMI) is independently associated with a higher mortality; however the relationship between DM and RVD is currently unknown. The purpose of this study was to determine whether DM is an independent predictor for the presence of right ventricular dysfunction (RVD) post STEMI.

An easy and reproducible parameter for the assessment of the pressure gradient in patients with aortic stenosis disease: A magnetic resonance study.

Aim: Cardiovascular magnetic resonance (CMR) has been increasingly used as an alternative method to evaluate the severity of aortic stenosis. The aim of our study was to evaluate whether the indirect measurement of the aortic gradient (Calc-PG), derived from Gorlin's formula, is a reproducible parameter for gradient assessment. Then, we evaluated if this parameter is correlated with left ventricular hypertrophy, considered as a marker of severity of aortic stenosis, better than phase-contrast sequences-derived pressure gradient (PC-PG) and aortic valve area.

Evolution of right ventricular function post-acute ST elevation myocardial infarction.

Purpose: To characterize the evolution of right ventricular (RV) function post-myocardial infarction (MI), to describe the culprit vessel involved with RV injury and to assess the concordance between RV injury on magnetic resonance imaging (MRI) and RV infarct on electrocardiogram (EKG).

Materials And Methods: Thirty-one patients underwent cardiovascular magnetic resonance (CMR) examinations at three time frames post-ST elevation MI (STEMI).

Results: Of those with an initial normal scan, RV function did not significantly change over time (60.

Comparison of the frequencies of myocardial edema determined by cardiac magnetic resonance in diabetic versus nondiabetic patients having percutaneous coronary intervention for ST elevation myocardial infarction.

The specific mechanisms by which diabetes may affect the myocardial tissue response to ischemia are unclear. Our objective was to prospectively quantify the degree of myocardial edema in diabetics versus nondiabetics with ST elevation myocardial infarction using cardiac magnetic resonance. Fifty-two patients (16 diabetics and 36 nondiabetics) were enrolled after primary percutaneous coronary intervention and underwent cardiac magnetic resonance on a 1.

The effect of percutaneous coronary intervention of chronically totally occluded coronary arteries on left ventricular global and regional systolic function.

Background: Percutaneous coronary intervention (PCI) is frequently attempted to open chronic total occlusions (CTOs) and restore epicardial coronary flow. Data suggest adverse outcomes in the case of PCI failure. We hypothesized that failure to open a CTO might adversely affect regional cardiac function and promote deleterious cardiac remodelling, and success would improve global and regional cardiac function assessed using cardiac magnetic resonance and velocity vector imaging.

Multi-contrast late enhancement CMR determined gray zone and papillary muscle involvement predict appropriate ICD therapy in patients with ischemic heart disease.

Background: Myocardial infarct heterogeneity indices including peri-infarct gray zone are predictors for spontaneous ventricular arrhythmias events after ICD implantation in patients with ischemic heart disease. In this study we hypothesize that the extent of peri-infarct gray zone and papillary muscle infarct scores determined by a new multi-contrast late enhancement (MCLE) method may predict appropriate ICD therapy in patients with ischemic heart disease.

Methods: The cardiovascular magnetic resonance (CMR) protocol included LV functional parameter assessment and late gadolinium enhancement (LGE) CMR using the conventional method and MCLE post-contrast.

Correlation of late gadolinium enhancement MRI and quantitative T2 measurement in cardiac sarcoidosis.

Purpose: To investigate the potentially improved detection and quantification of cardiac involvement using novel late-gadolinium-enhancement (LGE) cardiac magnetic resonance imaging (MRI) and quantitative T2 measurement to achieve better myocardial tissue characterization in systemic sarcoidosis.

Materials And Methods: Twenty-eight patients with systemic sarcoidosis underwent a cardiac magnetic resonance imaging (CMR) study on a 1.5T system.

Cardiac magnetic resonance evaluation of the impact of interventricular and intraventricular dyssynchrony on cardiac ventricular systolic and diastolic function in patients with isolated left bundle branch block.

Ventricular dyssynchrony significantly impairs cardiac performance. However, the independent role of interventricular dyssynchrony (interVD) and intraventricular dyssynchrony (intraVD) in the development of abnormalities of systolic and diastolic performance is unclear. Cardiac magnetic resonance imaging was performed in 39 patients with left bundle branch block and 13 healthy patients.

Characterizing myocardial edema and hemorrhage using quantitative T2 and T2* mapping at multiple time intervals post ST-segment elevation myocardial infarction.

Background: Accurate characterization of the longitudinal trends of myocardial edema and hemorrhage has been previously limited by subjective qualitative methods. We aimed to prospectively characterize the evolution of myocardial edema and hemorrhage post acute myocardial infarction using quantitative measures.

Methods And Results: Sixty-two patients were enrolled post primary percutaneous coronary intervention and underwent cardiovascular magnetic resonance on a 1.

Thrombus aspiration during primary percutaneous coronary intervention is associated with reduced myocardial edema, hemorrhage, microvascular obstruction and left ventricular remodeling.

Background: Thrombus aspiration (TA) has been shown to improve microvascular perfusion during primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI). The objective of our study was to assess the relationship between TA and myocardial edema, myocardial hemorrhage, microvascular obstruction (MVO) and left ventricular remodeling in STEMI patients using cardiovascular magnetic resonance (CMR).

Methods: Sixty patients were enrolled post primary PCI and underwent CMR on a 1.

Relation of mitral valve prolapse to basal left ventricular hypertrophy as determined by cardiac magnetic resonance imaging.

We aimed to characterize the extent and distribution of focal basal left ventricular (LV) hypertrophy in patients with mitral valve prolapse (MVP). Sixty-three patients (mean age: 58 ± 14 years) with MVP and 20 age-matched normal volunteers (mean age: 53 ± 11 years) were assessed using cardiac magnetic resonance imaging. We compared the ratio of basal to mid end-diastolic wall thickness in both groups and correlated it with clinical and imaging parameters.

Long-term safety and effectiveness of drug-eluting stents for the treatment of saphenous vein grafts disease: a population-based study.

Objectives: The purpose of this study was to evaluate the long-term safety and effectiveness of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease.

Background: DES are frequently implanted for SVG interventions, but some studies have shown that they are not effective in reducing target vessel revascularization (TVR) over longer-term follow-up. Some studies suggest there is increased mortality with DES compared with bare-metal stents (BMS).

Occluded stent in an extraluminal plane of the right coronary artery.

Coronary angiography demonstrated an occluded stent outside the lumen in the right coronary artery of a patient presenting with an acute coronary syndrome. Computed tomography confirmed the extraluminal location of the occluded stent. This finding is likely due to deployment of the stent in a dissection plane.

Post-trial period surveillance for randomised controlled cardiovascular studies: submitted protocols, consent forms and the role of the ethics board.

Background: The post-trial period is the time period after the end of study drug administration. It is unclear whether post-trial arrangements for patient surveillance are routinely included in study protocols and consents, and whether research ethics boards (REB) consider the post-trial period.

Objectives: The objective was to determine whether trial protocols and consent forms reviewed by the REB describe procedures for post-trial period surveillance.

Percutaneous coronary intervention with vs without on-site cardiac surgery backup: a systematic review and meta-analysis.

Although the popularity of performing percutaneous coronary intervention (PCI) in centres without on-site cardiac surgery backup is increasing, the safety of this practice is unknown. Our goal was to perform a systematic review and meta-analysis of PCI with and without on-site cardiac surgery backup. We identified studies using computerized literature searches through July 2009.

Paradoxical use of invasive cardiac procedures for patients with non-ST segment elevation myocardial infarction: an international perspective from the CRUSADE Initiative and the Canadian ACS Registries I and II.

Background: Practice guidelines support an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes, particularly in those at higher risk.

Objectives: To compare North American rates of invasive cardiac procedure use stratified by risk.

Methods: Use of invasive cardiac procedures and other care patterns in patients with non-ST segment elevation acute coronary syndromes from the United States (US) Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) National Quality Improvement Initiative (n=88,097; 465 hospitals) and Canadian ACS Registries I (n=1270; 51 hospitals) and II (n=1473; 36 hospitals) were compared after dividing patients into different risk categories based on predicted risk of in-hospital mortality.

Comparison of outcomes of phase II studies and subsequent randomized control studies using identical chemotherapeutic regimens.

Purpose: To determine whether promising results from phase II studies could be reproduced in phase III studies, and to examine which characteristics of phase II studies might be of predictive value for subsequent phase III studies.

Methods: We searched for all phase III studies of chemotherapy in advanced solid malignancies, published in the English language literature from July 1998 to June 2003. Each phase III study was reviewed to identify preceding phase II studies.