Supported by biomedical and health services research and clinical trials, and resourced by $4.81 million (2012-15), the objectives in Theme 2 centre around improvement of outcomes related to coronary disease, heart failure, arrhythmia and valve disease. We are leading international collaborations on non-invasive imaging of microvascular myocardial function as a novel marker for covert heart failure and target for medical and interventional therapy. We are leading international collaborations to examine non-invasive imaging measures of myocardial oxygenation reserve to diagnose sub-clinical coronary disease and the impact of medical therapy on measures of microvascular markers of cardiac function. The Technology Assessment Unit of the MUHC provides systematic evaluation of efficacy, safety, cost- effectiveness and social impact of technology in cardiovascular disease and complex coronary interventions. In Quebec we are leading a series of AMI (Acute Myocardial Infarct) studies for first-time analysis of quality metrics and appropriateness criteria for complex percutaneous coronary interventions relative to cost effectiveness and improved outcomes. Spanning mathematical modeling to population level comparative effectiveness trials, the study of arrythmia in complex disease has grown synchronous with the establishment of the McGill Electrophysiology Centre where we are leading international collaborations to generate evidence for optimal management of atrial fibrillation.