Cardiovascular medicine at the Québec Heart and Lung Institute

Celebrating 60 years of excellence in specialized clinical care and research Founded in 1918, what would eventually become the Québec Heart and Lung Institute [in French, the Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval (IUCPQ-UL)] was initially built as a sanatorium to offer the most contemporary treatments at the time to patients with tuberculosis. In 1955, clinicians of the centre felt that there was a need to build a pavilion that would be entirely devoted to research. Two years later, a Department of Cardiology was created and the mission of the hospital evolved, allowing scientists to initiate an additional research program on the aetiology and treatment of cardiovascular disease. In 1979, a pavilion devoted to prevention was built, showing the importance given to this field by our institution. In the 80’s, themes of excellence in research began to emerge beyond the contribution of individual pioneers of the time. During that period, one of our prominent academic cardiologists, Dr. Gilles Dagenais, launched the Québec Cardiovascular Study, a prospective observational study of middle-aged men which would then make, in the 90’s, several seminal contributions to cardiovascular epidemiology by reporting original findings in high-impact journals. As of today, these articles remain the most cited original articles ever published in cardiovascular medicine from our Institute. At the same time, the late Dr. Paul Cartier, one of our leading heart surgeons, had the vision of developing a heart surgery registry, a database which is still in place, providing a very rich source of information for basic and clinical scientists of our Institute. In 1999 began the first of several phases of expansion of the IUCPQ-UL Research Centre. In addition, an ‘Obesity and Metabolism’ axis was added, bringing a contingent of already internationally renowned scientists to the Institute. These scientists brought an additional perspective to the Institute and very fruitful interactions and collaborations were initiated which led to the emergence of the ‘Cardiometabolic Health’ theme, a notion now widely embraced by numerous organisations around the world. The IUCPQ-UL is proud of its international leadership in this area. We now have three overlapping research axes (Cardiology, Respiratory, Obesity, and Metabolism) perfectly aligned to the clinical activities of our Institute, which makes it unique as opposed to other heart centres in Canada. Thus, since the beginning of the millennium and over a period of 15 years, more than $60M have been invested in expanding the research centre (facilities entirely devoted to clinical research, new animal facilities, a cardiometabolic and respiratory health unit, a brand new imaging centre, several wet lab facilities for our basic scientists and several core laboratories for in-house and international studies). During that period of a decade and a half, our Institute has displayed a remarkable productivity with more than 4800 articles published in peer-reviewed journals including the mainstream general medicine and specialty journals. The centre now hosts 150 scientists and a total staff of 850 people. Although our three large divisions (Cardiology, Respiratory, Obesity, and Metabolism) have all contributed to the success and growth of our Institute, the Division of Cardiology has played a major role in the progression of the clinical and research activities of the IUCPQ-UL. The division, operating under the name ‘Multidisciplinary Department of Cardiology’, is headed by an interventional cardiologist, Dr. Robert De Larochellière. The multidisciplinary department also includes a Division of Heart Surgery led by Dr. François Dagenais. The Department thus includes 11 heart surgeons and 37 cardiologists with all the expertise (13 interventional cardiologists, 10 electrophysiologists, 9 cardiologists managing heart failure patients, 9 echocardiographers and clinical cardiologists including those involved in cardiovascular prevention and rehabilitation—please note that some cardiologists have activities in more than one subspecialty) to provide the required tertiary services in cardiology. The large clinical volume of the Institute is accounted for by the fact that it has to provide tertiary care to a population of about 3 million individuals. Table 1 describes the key clinical activities/procedures performed at the Québec Heart and Lung Institute. Main clinical activities/procedures performed at the Multidisciplinary Department of Cardiology of the Québec Heart and Lung Institute (IUCPQ-UL) in 2014–15 aRapidly growing programs; CABG, coronary artery bypass graft; CTO, chronic total occlusion; EP, electrophysiology; LAA, left atrial appendage; PCI, percutaneous coronary intervention; TAVI, transcatheter aortic valve implantation. Main clinical activities/procedures performed at the Multidisciplinary Department of Cardiology of the Québec Heart and Lung Institute (IUCPQ-UL) in 2014–15 aRapidly growing programs; CABG, coronary artery bypass graft; CTO, chronic total occlusion; EP, electrophysiology; LAA, left atrial appendage; PCI, percutaneous coronary intervention; TAVI, transcatheter aortic valve implantation. Progression in the number of peer-reviewed publications at theQuébec Heart and Lung Institute.Open bars: Total number of publications per year; Closed bars: Publications from the Multidisciplinary Department of Cardiology. Because the constant dialogue between clinicians and basic scientists is in its DNA expression, the Institute provides a very fertile environment leading to productive, basic, translational, clinical, and population research. Although our research interests and activities are wide, they can be regrouped into four overall areas: electrophysiology, coronary heart disease, cardiometabolic disease and prevention, and valvular diseases. All of them have investigators involved in studies addressing aetiology and treatment/prevention approaches. Numerous research platforms and core labs have been developed, allowing our investigators to access the modern tools essential for conducting their basic, clinical, and translational research. Finally, several of our leaders have been able to secure prestigious and competitive scholarships or chair positions, playing significant roles at the international level and contributing to academic excellence in cardiology (Table 2). Clinicians and investigators having received competitive FRQ-Sa scholarships and/or holding chair positions at the Multidisciplinary Department of Cardiology of the Québec Heart and Lung Institute aFRQ-S: Fonds de recherche du Québec—Santé. Clinicians and investigators having received competitive FRQ-Sa scholarships and/or holding chair positions at the Multidisciplinary Department of Cardiology of the Québec Heart and Lung Institute aFRQ-S: Fonds de recherche du Québec—Santé. Research is one of the priorities of the Institute and an annual intra-mural peer-reviewed grant competition provides additional competitive funding to support excellence in research. Several of our investigators have also secured competitive scholarship from our provincial health research agency (Fonds de recherche du Québec—Santé), allowing them to protect 50% of their time for research. With its rich historical legacy of 100 years and its formidable growth over less than two decades, the IUCPQ-UL has become a key player in academic medicine in Canada contributing to remarkable advances in care, research and education. The Multidisciplinary Department of Cardiology is proud and privileged to be niched in such a rich environment. Several of our investigators are world leaders in their field and we anticipate a bright future not only in our battle against cardiovascular disease but also in the promotion of cardiovascular health. Finally, within our Institute, the Multidisciplinary Department of Cardiology provides a stimulating environment also permissive to productive collaborations between clinical and basic scientists, making it a unique epicentre of excellence in cardiovascular medicine and health. Our past is rich and our future looks bright!

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