Treatment delays in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction at the Quebec Heart and Lung Institute.

Background: Current guidelines for ST elevation myocardial infarction (STEMI) recommend performing primary percutaneous coronary intervention (PCI) within 90 min of hospital arrival. However, recent data suggest that in a real-world setting, median door-to-balloon (DTB) time is closer to 180 min for transfer patients, with less than 5% of patients being treated within 90 min. A retrospective observational study was conducted to assess time to treatment in patients undergoing primary PCI at the Quebec Heart and Lung Institute (QHLI).

Direction of persistent ischemic mitral jet after restrictive valve annuloplasty: implications for interpretation of perioperative echocardiography.

Background: Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty (MVA) and is associated with a poor prognosis. It was hypothesized that the anterior displacement of the posterior aspect of the annulus caused by annuloplasty could induce a change in the direction of MR jet.

Methods: The echocardiograms of 21 patients who underwent restrictive MVA for ischemic MR and who had detectable postoperative MR were analyzed before and early after surgery to evaluate the direction of MR jet.

New concepts in valvular hemodynamics: implications for diagnosis and treatment of aortic stenosis.

Aortic valve stenosis (AS) is the third-most frequent heart disease after coronary artery disease and arterial hypertension, and it is associated with a high incidence of adverse outcomes. Recent data support the notion that AS is not an isolated disease uniquely limited to the valve. Indeed, AS is frequently associated with abnormalities of the systemic arterial system, and, in particular, with reduced arterial compliance, which may have important consequences for the pathophysiology and clinical outcome of this disease.

The 'valvulo-metabolic' risk in calcific aortic valve disease.

Calcific aortic stenosis (AS) has been considered a degenerative and unmodifiable process resulting from aging and 'wear and tear' of the aortic valve. Over the past decade, studies in the field of epidemiology, molecular biology and lipid metabolism have highlighted similarities between vascular atherosclerosis and calcific AS. In particular, work from the Quebec Heart Institute and from that of others has documented evidence of valvular infiltration by oxidized low-density lipoproteins and the presence of inflammatory cells, along with important tissue remodelling in valves explanted from patients with AS.

Ischemic, genetic and pharmacological origins of cardiac arrhythmias: the contribution of the Quebec Heart Institute.

Research in the field of basic electrophysiology at the Quebec Heart Institute (Laval Hospital, Quebec City, Quebec) has evolved since its beginning in the 1990s. Interests were focused on cardiac arrhythmias induced by drugs, allelic variants and metabolic factors produced during ischemia. The results have contributed to the creation of new standards in drug development, more specifically, testing all new drugs for their potential effects on cardiac potassium currents, which could produce life-threatening proarrhythmic effects.

Coronary vasoregulation in health and disease.

The present article reviews pertinent contributions from the Coronary Physiology Research Group at the Quebec Heart Institute to the understanding of coronary physiology in health and disease. Mechanisms that contribute to regulation of coronary blood flow and its distribution across the ventricular wall are discussed. Data from animal studies of ischemia-reperfusion injury are also presented and discussed in the context of current concepts regarding postischemic myocardial protection strategies.

The Quebec Heart Institute: 50 years of excellence in cardiology.

The Quebec Heart Institute was established in 1957 at the Laval Hospital in Sainte-Foy, Quebec. Since then, clinical and research activities have made this Institute one of the largest tertiary care cardiology centres in Canada. With its vast catchment area of more than 3,000,000 people, the Institute has developed a strong collaboration with referral physicians centred on clinical, teaching and research interests.

Safety and magnitude of changes in blood glucose levels following exercise performed in the fasted and the postprandial state in men with type 2 diabetes.

Background: Information on the extent to which acute exercise reduces blood glucose levels (BGL) in type 2 diabetes is lacking. For this reason, the effects of exercise initiated at different preexercise BGL were assessed in men with type 2 diabetes both in the fasted (FS) and the postprandial states (PS).

Design And Methods: Forty-three men with type 2 diabetes, 12 on diet alone and 31 on hypoglycaemic agents, completed a total of 1555 exercise sessions performed in the FS and 0-1, 1-2, 2-3, 3-4, 4-5, and 5-8 h in the PS.

Life-threatening left atrial wall hematoma secondary to a pulmonary vein laceration: an unusual complication of catheter ablation for atrial fibrillation.

Background: Several complications may occur during catheter ablation for atrial fibrillation (AF). We report an unusual case of left atrial wall hematoma without pericardial effusion secondary to a right inferior pulmonary vein (PV) laceration. The use of real-time transesophageal echocardiography (TEE) during the procedure can be useful for early detection of this potentially lethal complication.

Enhanced lung disease and Th2 response following human metapneumovirus infection in mice immunized with the inactivated virus.

Human metapneumovirus (hMPV) is a paramyxovirus that causes acute respiratory-tract infections in humans. The histopathological and immunological responses to hMPV infection in BALB/c mice immunized with inactivated hMPV were characterized. Animals were immunized intraperitoneally with PBS, supernatant from non-infected LLC-MK2 cells and from heat-inactivated influenza A- or hMPV-infected cells, all in incomplete Freund's adjuvant, or with heat-inactivated hMPV without adjuvant, and then infected intranasally with 10(8) TCID50 virus.

Normalization of diastolic dysfunction in type 2 diabetics after exercise training.

Purpose: The purpose of this study was to evaluate the impact of aerobic exercise training on left ventricular diastolic dysfunction (LVDD) and exercise capacity in subjects with type 2 diabetes.

Methods: Twenty-three sedentary subjects with well-controlled type 2 diabetes, free of coronary disease and having different degrees of LVDD, participated in the study. Subjects were treated with oral hypoglycemic agents and/or diet.

Association between plasma LDL particle size, valvular accumulation of oxidized LDL, and inflammation in patients with aortic stenosis.

Objective: In patients with severe aortic stenosis (AS), we examine the association between: (1) the content of oxidized LDL (oxLDL) in the aortic valve and the degree of inflammation and remodeling; (2) The proportion of small dense LDL particles in the plasma and the presence of oxLDL in the valve along with hemodynamic progression of valve stenosis.

Methods And Results: We have examined 102 explanted AS valves. Tissue remodeling, inflammation, and accumulation of oxLDL were determined.

Association between circulating oxidised low-density lipoprotein and fibrocalcific remodelling of the aortic valve in aortic stenosis.

Introduction: Aortic stenosis (AS) is the most common valvular heart disease in westernized societies. AS is a disease process akin to atherosclerosis in which calcification and tissue remodelling play a crucial role. In patients with moderate/severe AS, we sought to determine whether the remodelling process would be in relationship with transvalvular gradients and circulating oxidised low-density lipoprotein (ox-LDL) levels.

Awakening cortisol response in relation to psychosocial profiles and eating behaviors.

Awakening cortisol response was measured in 78 men and women, on 3 mornings within a 2-month period. Psychosocial and eating behavior variables were assessed using self-administered questionnaires on anxiety (State-Trait Anxiety Inventory), depression (Beck Depression Inventory), body esteem (Body Esteem Scale for Adolescents and Adults), and eating behaviors (Three-Factor Eating Questionnaire and Eating Disorder Inventory-2). Data on food intake and appetite sensations were also collected using a buffet-type meal test, a 3-day food record and visual analog scales measured before and after a standardized breakfast meal test.

Energy expenditure: a critical determinant of energy balance with key hypothalamic controls.

Energy stores are regulated through complex neural controls exerted on both food intake and energy expenditure. These controls are insured by interconnected neurons that produce different peptides or classic neurotransmitters, which have been regrouped into anabolic' and catabolic' systems. While the control of energy intake has been addressed in numerous investigations, that of energy expenditure has, as yet, only received a moderate interest, even though energy expenditure represents a key determinant of energy balance.

Left atrial papillary fibroelastoma: a rare cause of multiple cerebral emboli.

Papillary fibroelastomas have been increasingly described since the widespread use of cardiac echocardiography. Most often diagnosed incidentally, papillary fibroelastomas may embolize, mainly to the cerebral circulation. The aortic valve is predominantly affected.

Subpleural hibernoma.

Here we report the case of a 41-year-old man with an asymptomatic, 5-cm, pleural-based mass excised by thoracoscopy. We also review the clinical, radiologic, and pathologic features of hibernomas.

Congenital absence of the pericardium presenting as acute myocardial necrosis.

Congenital absence of the pericardium is a rare defect of which recognition is critical because it can be associated with catastrophic outcomes. While some carriers of this condition may present with a lethal complication, most are asymptomatic, and the defect is found incidentally. The case of a 49-year-old woman is described who presented with acute myocardial necrosis and absence of obstructive coronary artery disease, and in whom a complete left pericardial defect was found.

Long-term impact of diabetes and its comorbidities in patients undergoing isolated primary coronary artery bypass graft surgery.

Background: The objective of this study was to identify the impact of diabetes and related comorbidities, namely chronic renal failure, peripheral vascular disease, and low ejection fraction (<35%), on long-term survival of patients undergoing coronary artery bypass graft surgery.

Methods And Results: A unicenter study was conducted on 9125 survivors of isolated coronary artery bypass graft surgery between 1992 and 2002. There were 6581 nondiabetic patients and 2544 diabetics, including 1809 patients with noninsulin-dependent diabetes mellitus and 735 patients with insulin-dependent diabetes mellitus.

Impact of fasting and postprandial state on plasma carnitine concentrations during aerobic exercise in type 2 diabetes.

The effects of metabolic states of fasting and post-absorption on plasma concentrations of free carnitine (FC), acylcarnitine (AC) and total carnitine (TC) were compared during submaximal exercise in subjects with type 2 diabetes mellitus. Ten sedentary men (54+/-5 years) treated with oral hypoglycaemic agents were tested on two separate occasions: following an overnight fast and 2 h after a 395-kcal standardised breakfast. Exercise was performed at 60% of [Formula: see text]O(2peak) on a cycle ergometer for 60 min.

Predictors of aorto-saphenous vein bypass narrowing late after coronary artery bypass grafting.

The objective of this study was to evaluate the clinical and angiographic factors associated with significant saphenous vein graft (SVG) atherosclerosis progression at mid-term follow-up in a series of unselected coronary patients who had previously received a coronary artery bypass graft (CABG). A total of 123 SVGs from 86 patients who underwent cardiac catheterization twice, 15 +/- 12 months apart, were included in the study. None of the SVGs presented any > or =50% diameter stenosis (DS) lesion or underwent any intervention at baseline.