Mechanical dyssynchrony is a common phenomenon in patients with congestive heart failure, which usually identified by noninvasive cardiac imaging tools such as echocardiography. It demonstrates electromechanical delay in some regions of the failing heart which in turn contributes to further impairment of cardiac function. The diagnostic, therapeutic and prognostic values of mechanical dyssynchrony have been reported in a number of studies. Therefore, this review describes briefly the methods of measurement, but more importantly, explains the clinical implication of its assessment in heart failure related aspects including cardiac resynchronization therapy, functional mitral regurgitation, diastolic heart failure and mortality.
Cardiac Resynchronization Therapy ; Echocardiography ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Humans ; Mitral Valve Insufficiency

No abstract available.
Cardiac Resynchronization Therapy* ; Echocardiography*

BACKGROUNDChronic heart failure (CHF) is a severe clinical syndrome associated with high morbidity and mortality, and with high health care expenditures. No nationwide data are currently available regarding the quality of clinical management of CHF patients in China. The aim of this study was to assess the quality of care of CHF inpatients in China.

METHODSThe American College of Cardiology/American Heart Association Clinical Performance Measures for Adults with Chronic Heart Failure (Inpatient Measurement Set) with slight modifications was used to measure the performance status in 612 CHF patients with acute coronary syndrome (ACS) from 65 hospitals across all regions of China.

RESULTSThe implementation rates of guideline recommended strategies for CHF management were low. Only 57.5% of the CHF patients received complete discharge instructions, 53.6% of the patients received evaluation of left ventricular systolic function, 62.8% received an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker at discharge, and 52.7% received a β-blocker at discharge, 56.3% of the smokers received smoking cessation counseling. The rate of warfarin utilization was only 9.7% in CHF patients with atrial fibrillation. Most patients (81.4%) did not receive all the first four treatments. There were marked differences in the quality of CHF management among patients with different characteristics.

CONCLUSIONSPerformance measures provide a standardized method of assessing quality of care, and can thus highlight problems in disease management in clinical practice. The quality of care for CHF patients with ACS in China needs to be improved.

Acute Coronary Syndrome ; therapy ; Aged ; China ; Female ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged ; Quality of Health Care ; Secondary Prevention ; Sex Characteristics

PURPOSE: The aim of this study was to validate a computational fluid dynamics (CFD) simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms. METHODS: Computational and physical models of patient-specific bifurcation and sidewall aneurysms were constructed from computed tomography angiography with use of stereolithography, a three-dimensional printing technology. Flow dynamics parameters before and after flow-diverter treatment were measured with pulse-wave and color Doppler ultrasonography, and then compared with CFD simulations. RESULTS: CFD simulations showed drastic flow reduction after flow-diverter treatment in both aneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysm and the side-wall aneurysm, respectively. Velocity contour plots from computer simulations before and after flow diversion closely resembled the patterns obtained by color Doppler ultrasonography. CONCLUSION: The CFD estimation of flow reduction in aneurysms treated with a flow-diverting stent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcation and side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasible and reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.
Aneurysm ; Angiography ; Computer Simulation ; Endovascular Procedures ; Hydrodynamics ; Intracranial Aneurysm* ; Stents ; Ultrasonography ; Ultrasonography, Doppler* ; Ultrasonography, Doppler, Color