Level Of Risk Research Articles

Credit risk and Tunisian bank stability in the Covid-19 wave

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Times New Roman,Times,serif"><span dir="ltr" lang="EN-US"><span style="color:black">Banks are at the core of economic functioning in various countries and are the cause of their development in various fields. In a changing environment, they must deal with certain risks and maintain financial stability as the ultimate objective. The primary objective of this study is to examine the correlation between credit risk and bank stability within the Tunisian banking sector, with a specific focus on understanding the moderating impact of the COVID-19 pandemic. To achieve this, we employ several econometric techniques, including panel unit root and cointegration tests, panel Vector Error Correction Model (VECM), Fully Modified Ordinary Least Squares (FMOLS), and Dynamic Ordinary Least Squares (DOLS). Our empirical analysis relies on a panel dataset that encompasses a comprehensive sample of 8 Tunisian banks over 2000-2020. The results of our analysis unveil a significant negative relationship between credit risk and bank stability, indicating that higher levels of credit risk exert a detrimental effect on the overall stability of Tunisian banks. Furthermore, our study highlights that this adverse impact is further exacerbated during the COVID-19 pandemic, suggesting that the pandemic acts as a moderator. The findings of this study hold substantial implications for policymakers, regulators, and bank managers in Tunisia. They emphasize the critical importance of implementing robust risk management practices to mitigate credit risk and bolster bank stability. Additionally, the research underscores the need to consider the unique challenges introduced by external shocks, such as the COVID-19 pandemic, when assessing the overall stability of the banking system.</span></span></span></span></p>

Assessment of a multivariable model using MRI-radiomics, age and sex for the classification of hepatocellular adenoma subtypes

ObjectivesNon-invasive subtyping of hepatocellular adenomas (HCA) remains challenging for several subtypes, thus carrying different levels of risks and management. The goal of this study is to devise a multivariable diagnostic model based on basic clinical features (age and sex) combined with MRI-radiomics and to evaluate its diagnostic performance. MethodsThis single-center retrospective case-control study included all consecutive patients with HCA identified within the pathological database from our institution from January 2003 to April 2018 with MRI examination (T2, T1-no injection/injection-arterial-portal); volumes of interest were manually delineated in adenomas and 38 textural features were extracted (LIFEx, v5.10). Qualitative (i.e., visual on MRI) and automatic (computer-assisted) analysis were compared. The prognostic scores of a multivariable diagnostic model based on basic clinical features (age and sex) combined with MRI-radiomics (tumor volume and texture features) were assessed using a cross-validated Random Forest algorithm. ResultsVia visual MR-analysis, HCA subgroups could be classified with balanced accuracies of 80.8 % (I-HCA or ß-I-HCA, the two being indistinguishable), 81.8 % (H-HCA) and 74.4 % (sh-HCA or ß-HCA also indistinguishable). Using a model including age, sex, volume and texture variables, HCA subgroups were predicted (multivariate classification) with an averaged balanced accuracy of 58.6 %, best=73.8 % (sh-HCA) and 71.9 % (ß-HCA). I-HCA and ß-I-HCA could be also distinguished (binary classification) with a balanced accuracy of 73 %. ConclusionMultiple HCA subtyping could be improved using machine-learning algorithms including two clinical features, i.e., age and sex, combined with MRI-radiomics. Future HCA studies enrolling more patients will further test the validity of the model.

Prefecture-level health risk assessment for hot extremes in China

Evaluating prefecture-level health risks for hot extremes is the core of localized adaptation measures to mitigate negative heat-related impacts. Here, by applying the heat hazard-human exposure-social vulnerability framework, we assessed the prefecture-level health risk for summertime hot extremes in China, with multisource data from 329 prefecture units. Regions suffering very high and high levels of health risk were observed in several main basins and plains, including the Turpan Basin, the North China Plain, the middle-lower Yangtze River Plain, the Pearl River Delta, the Chengdu Plain, and the Wei River Valley. Health risk structures were identified, and 72 prefecture units (22%) were found in the risk zone of Hh-He-Hv (high heat hazard, high human exposure, and high social vulnerability), of which 44% of sites were distributed in the North China Plain and must be prioritized for adaptation. The risk components of human exposure were the main drivers of health risk and its spatial heterogeneity. For the southeastern region, social vulnerability plays a more significant role than heat hazard. Four types of social vulnerability were summarized and will be useful for targeted adaptation plans. The assessment process will be insightful and can be applied in other countries or on a global scale.

Risk, Sensitive Analysis, and Optimization of a New Multi-generation System Activated by Solar and Biomass Energies

In recent years, the use of clean energies has become much more important due to the increase of environmental pollutants and the reduction of fossil fuel resources. Another important parameter in the establishment of energy systems is the assessment of the risks caused by the construction of the system and the provision of operational solutions to manage and reduce these risks. In this research, a new multi-generation system that is activated using solar and biomass energies has been evaluated thermodynamically and thermo-risky. This system consists of a Brayton cycle, a steam Rankine cycle, a transcritical CO2 cycle, a proton membrane electrolyzer (PEME) unit, and an internal combustion engine (ICE). A notable characteristic of the proposed system is its capability to recover waste heat from the gas turbine cycle, which is subsequently utilized to drive both a steam Rankine cycle and a transcritical CO2 cycle. The sensitivity analysis has been performed to investigate the effects of the input parameters on the system performance and finally, an optimization for the effective parameters of the system has been conducted. The results of the calculations show that the proposed system has energy and exergy efficiencies of 22.05% and 15.93%, respectively. The risk analysis was conducted by considering the potential hazards such as jet fires, jet of combusted gases, and system overpressure. The analysis indicates that the system poses a low level of risk. The overall risk, along with the risk per unit of system exergy, has been estimated at 4.247 ×10-8 injuries/year and 3.73 ×10-11 injuries/year.kW, respectively. In optimal conditions, the energy and exergy efficiency of the system reaches 25.79% and 19.08%.

Individualized radiology screening for newly diagnosed nasopharyngeal carcinoma

ObjectivesCurrent guidelines recommend universal PET/CT screening for metastases staging in newly diagnosed nasopharyngeal carcinoma (NPC) despite the low rate of synchronous distant metastasis (SDM). The study aims to achieve individualized screening recommendations of NPC based on the risk of SDM. Methods and materials18 pre-treatment peripheral blood indicators was retrospectively collected from 2271 primary NPC patients. A peripheral blood risk score (PBRS) was constructed by indicators associated with SDM on least absolute shrinkage and selection operator (LASSO) regression. The PBRS-based distant metastases (PBDM) model was developed from features selected by logistic regression analyses in the training cohort and then validated in the validation cohort. Receiver operator characteristic curve analysis, calibration curves, and decision curve analysis were applied to evaluate PBDM model performance. ResultsPre-treatment Epstein–Barr viral DNA copy number, percentage of total lymphocytes, serum lactate dehydrogenase level, and monocyte-to-lymphocyte ratio were most strongly associated with SDM in NPC and used to construct the PBRS. Sex (male), T stage (T3-4), N stage (N2-3), and PBRS (≥1.076) were identified as independent risk factors for SDM and applied in the PBDM model, which showed good performance. Through the model, patients in the training cohort were stratified into low-, medium-, and high-risk groups. Individualized screening recommendations were then developed for patients with differing risk levels. ConclusionThe PBDM model offers individualized recommendations for applying PET/CT for metastases staging in NPC, allowing more targeted screening of patients with greater risk of SDM compared with current recommendations.

Lipoprotein(a) Levels in Disaggregated Racial and Ethnic Subgroups Across Atherosclerotic Cardiovascular Disease Risk Levels

BackgroundLipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). ObjectivesThe authors assessed differences in Lp(a) testing and levels by disaggregated race, ethnicity, and ASCVD risk. MethodsThis was a retrospective cohort study of patients from a large California health care system from 2010 to 2021. Eligible individuals were ≥18 years old, with ≥2 primary care visits, and complete race and ethnicity data who underwent Lp(a) testing. Race and ethnicity were self-reported and categorized as follows: non-Hispanic (NH) White, NH-Black, Hispanic (Mexican, Puerto Rican, other), NH-Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other). Logistic regression models tested associations between elevated Lp(a) (≥50 mg/dL) and race, ethnicity, and ASCVD risk. Results13,689 (0.9%) individuals underwent Lp(a) testing with a mean age of 54.6 ± 13.8 years, 49% female, 28.8% NH Asian. Over one-third of those tested had Lp(a) levels ≥50 mg/dL, ranging from 30.7% of Mexican patients to 62.6% of NH-Black patients. The ASCVD risk of those tested varied by race: 73.6% of Asian Indian individuals had <5% 10-year risk, whereas 27.2% of NH-Black had established ASCVD. Lp(a) prevalence ≥50 mg/dL increased across the ASCVD risk spectrum. After adjustment, Hispanic (OR: 0.76 [95% CI: 0.66-0.88]) and Asian (OR: 0.88 [95% CI: 0.81-0.96]) had lower odds of Lp(a) ≥50 mg/dL, whereas Black individuals had higher odds (OR: 2.46 [95% CI: 1.97-3.07]). ConclusionsLp(a) testing is performed infrequently. Of those tested, Lp(a) levels were frequently elevated and differed significantly across disaggregated race and ethnicity groups. The prevalence of elevated Lp(a) increased with increasing ASCVD risk, with significant variation by race and ethnicity.

Development of a decision support system for client acceptance in independent audit process

Intelligent Information Technology (IIT) applications are crucial in the audit process, enhancing quality, effectiveness, and efficiency. The client acceptance process (CAP), one of the critical audit steps, involves subjective evaluations where business managers' claims intersect with independent audit firm managers' expectations. This subjective nature introduces the potential for errors or misjudgments, impacting audit time and costs. In this paper, therefore, we propose a decision support system considering both auditors' subjective judgments and financial data variations for accepting or rejecting a client enterprise. The decision support system consisting of the Fuzzy Analytic Hierarchy Process (AHP), the logistic regression model, and the fuzzy inference system comprises four phases. In the first phase, a logistic regression model is developed using financial ratios to determine the client's probability of being in a close monitoring market (CMM) which represents publicly traded firms that are struggling to meet specific financial indicators or that are exposed to certain risks. In the second phase, the evaluation criteria used by the audit firm to measure the market reputation of the client enterprise are defined, and the weights of the evaluation criteria are obtained by using Fuzzy AHP. In the third phase, the Client Acceptance Score (CAS) representing market reputation of the client is calculated by incorporating the results of a reputation survey and applying the weights assigned to the evaluation criteria obtained in the second phase. Finally, client acceptance risk level (CARL) is obtained by using a fuzzy inference system and a rule-based defined by auditors. The CMM probability value and CAS score obtained in previous phases are used as input values of the fuzzy inference system. The CARL score guides the audit firm in deciding whether to engage with the client. To illustrate the applicability of the proposed model, a case study has been given in the paper.

Pulmonary embolism: Epidemiological and radiological aspects at the Niamey general reference hospital.

Introduction: Pulmonary Embolism is a diagnostic and therapeutic emergency. It is one of the clinical manifestations of venous thromboembolism (VTE) which is frequent and the most serious of the latter. The aim of our work is to study the characteristics of pulmonary embolism confirmed by chest CT angiography at the General Reference Hospital. More specifically, it is a question of describing the: epidemiological and radiological aspects of PE confirmed by chest CT angiography. Material and methods: This is a retrospective and prospective study, carried out at the Reference General Hospital over a period of 18 months: Retrospective over one (1) year from (July 2018 to June 2019), Prospective over six (6) months from July 2019 to December 2019. The study population included all patients referred to the radiology department for chest CT angiography with suspected pulmonary embolism and whose D-dimer dosage was greater than 500ng/ml. Chest x-ray and duplex ultrasound of the lower limbs were requested as additional basic examinations with the aim of exploring venous thromboembolic disease. Results: During this study, 84 chest CT angioscans were performed and 25 cases of pulmonary embolism were confirmed, representing a prevalence of 29.76%. The patients were classified according to the levels of clinical thromboembolic risk. Chest x-ray was performed in 16 patients or 64%. Cardiac Doppler ultrasound was performed in 16 patients (64%). Doppler ultrasound of the lower limbs was performed in only 3 patients. All patients had undergone chest CT angiography. Conclusion: The advent of chest CT angiography in the diagnostic approach allowed us to note an underestimation of the prevalence of PE in African countries. Thoracic CT angiography provided diagnostic confirmation.

Lower Limb Muscle Co-Activation Maps in Single and Team Lifting at Different Risk Levels

The central nervous system uses muscle co-activation for body coordination, effector movement control, and joint stabilization. However, co-activation increases compression and shear stresses on the joints. Lifting activity is one of the leading causes of work-related musculoskeletal problems worldwide, and it has been shown that when the risk level rises, lifting enhances trunk muscle co-activation at the L5/S1 level. This study aims to investigate the co-activation of lower limb muscles during liftings at various risk levels and lifting types (one-person and vs. two-person team lifting), to understand how the central nervous system governs lower limb rigidity during these tasks. The surface electromyographic signal of thirteen healthy volunteers (seven males and six females, age range: 29–48 years) was obtained over the trunk and right lower limb muscles while lifting in the sagittal plane. Then co-activation was computed according to different approaches: global, full leg, flexor, extensor, and rostro-caudal. The statistical analysis revealed a significant increase in the risk level and a decrease in the two-person on the mean and/or maximum of the co-activation in almost all the approaches. Overall, our findings imply that the central nervous system streamlines the motor regulation of lifting by increasing or reducing whole-limb rigidity within a distinct global, extensor, and rostro-caudal co-activation scheme, depending on the risk level/lifting type.

Association between atherosclerotic cardiovascular disease score and skin carotenoid levels estimated via refraction spectroscopy in the Japanese population: a cross-sectional study

Carotenoids play a role in preventing and impeding the progression of atherosclerotic cardiovascular diseases (ASCVDs) through their anti-oxidative effects. This study evaluated associations between ASCVD risk and skin carotenoid (SC) levels, reflecting dietary carotenoid intake. Participants’ ASCVD risk was assessed using the Hisayama ASCVD risk prediction model, and SC levels were measured through a reflection spectroscope (Veggie Meter). The associations between high ASCVD risk and SC levels were analyzed using logistic regression analysis and a restricted cubic spline (RCS) model. A total of 1130 men and women (mean age: 56 years) from participants who underwent a health examination in Seirei Center for Health Promotion and Prevention Medicine in 2019 and 2022 were analyzed. Of these, 4.6% had moderate or high ASCVD risk. Mean SC values were 236, 315, 376, 447, and 606 in quintile Q1 to Q5, respectively. The adjusted odds ratios (95% confidence intervals) of SC quintile for moderate- or high-risk ASCVD was 0.24 (0.12–0.51) in Q5 (495 ≤), 0.42 (0.23–0.77) in Q4, 0.50 (0.29–0.88) in Q3, and 0.68 (0.41–1.12) in Q2 compared to Q1 (< 281). High SC values continuously showed non-linear inverse association with moderate- or high-risk for ASCVD in Japanese adults. Non-invasive SC measurements may be a good indicator for recommending carotenoids to prevent cardiovascular disease.

Effectiveness of a chatbot in improving the mental wellbeing of health workers in Malawi during the COVID-19 pandemic: A randomized, controlled trial.

We conducted a randomized, controlled trial (RCT) to investigate our hypothesis that the interactive chatbot, Vitalk, is more effective in improving mental wellbeing and resilience outcomes of health workers in Malawi than the passive use of Internet resources. For our 2-arm, 8-week, parallel RCT (ISRCTN Registry: trial ID ISRCTN16378480), we recruited participants from 8 professional cadres from public and private healthcare facilities. The treatment arm used Vitalk; the control arm received links to Internet resources. The research team was blinded to the assignment. Of 1,584 participants randomly assigned to the treatment and control arms, 215 participants in the treatment and 296 in the control group completed baseline and endline anxiety assessments. Six assessments provided outcome measures for: anxiety (GAD-7); depression (PHQ-9); burnout (OLBI); loneliness (ULCA); resilience (RS-14); and resilience-building activities. We analyzed effectiveness using mixed-effects linear models, effect size estimates, and reliable change in risk levels. Results support our hypothesis. Difference-in-differences estimators showed that Vitalk reduced: depression (-0.68 [95% CI -1.15 to -0.21]); anxiety (-0.44 [95% CI -0.88 to 0.01]); and burnout (-0.58 [95% CI -1.32 to 0.15]). Changes in resilience (1.47 [95% CI 0.05 to 2.88]) and resilience-building activities (1.22 [95% CI 0.56 to 1.87]) were significantly greater in the treatment group. Our RCT produced a medium effect size for the treatment and a small effect size for the control group. This is the first RCT of a mental health app for healthcare workers during the COVID-19 pandemic in Southern Africa combining multiple mental wellbeing outcomes and measuring resilience and resilience-building activities. A substantial number of participants could have benefited from mental health support (1 in 8 reported anxiety and depression; 3 in 4 suffered burnout; and 1 in 4 had low resilience). Such help is not readily available in Malawi. Vitalk has the potential to fill this gap.

The influence of banking liquidity risk on profitability: The moderating role of capital adequacy ratio

The decline in bank liquidity due to slowing economic growth in Indonesia has decreased bank profitability. COVID-19 and the increase in the number of non-performing loans increased the level of bank liquidity risk and decreased capital. Hence, the purpose of this study is to analyze the influence of banking liquidity risk on profitability in the Indonesian banking sector and to examine the role of capital adequacy ratio as a moderating variable. The method section explains panel data analysis using the random-effect model in analyzing the influence of liquidity risk on profitability and the role of capital adequacy ratio as a moderating variable. The results of the analysis show that liquidity risk has a significant positive influence on profitability at the 1% significance level. Moreover, the t-statistic value for capital adequacy ratio as a moderating variable is 2.59 at a 1% significance level. This result shows that the capital adequacy ratio can moderate the relationship between liquidity risk and profitability. Furthermore, the robustness test results show that the deposit risk ratio is a good indicator for estimating liquidity risk. In addition, this study is useful for the banking sector in managing its capital adequacy ratio and as a reference for the government in setting policies related to banking capital.

Calculation of Copper Production Failure Risk Level Based on Aggregate Loss Cost

Calculation of Copper Production Failure Risk Level Based on Aggregate Loss Cost

Postural and ergonomic analysis of reading habits in elderly adults: a case study

Introduction: Proper posture is essential for preventing musculoskeletal disorders (MSDs) and ergonomic problems in elderly adults. This study aims to analyze the reading posture of elderly residents in the Esposos Bishara seniors’ residence, located in Tachina Parish, Esmeraldas Canton, Ecuador. Methods: A quantitative methodology was employed using the Rapid Entire Body Assessment (REBA) method to evaluate the reading postures of twelve elderly individuals aged between 63 and 99 years. Data were collected in designated reading spaces within the asylum. Results: The analysis revealed that the elderly participants exhibited medium to low risks of developing MSDs and ergonomic problems during reading activities. The predominant risk factors included neck flexion and prolonged static postures. Discussion: These findings align with existing literature that highlights the importance of ergonomic interventions in reducing MSD and ergonomic risks among elderly adults. The study underscores the need for ergonomic adjustments in reading environments to enhance postural health. Conclusion: The study concludes that while the risk levels are not alarmingly high, ergonomic modifications are necessary to mitigate potential MSDs in elderly readers. Future research should explore broader populations and varying reading environments.

AI-Related Risk: An Epistemological Approach

Risks connected with AI systems have become a recurrent topic in public and academic debates, and the European proposal for the AI Act explicitly adopts a risk-based tiered approach that associates different levels of regulation with different levels of risk. However, a comprehensive and general framework to think about AI-related risk is still lacking. In this work, we aim to provide an epistemological analysis of such risk building upon the existing literature on disaster risk analysis and reduction. We show how a multi-component analysis of risk, that distinguishes between the dimensions of hazard, exposure, and vulnerability, allows us to better understand the sources of AI-related risks and effectively intervene to mitigate them. This multi-component analysis also turns out to be particularly useful in the case of general-purpose and experimental AI systems, for which it is often hard to perform both ex-ante and ex-post risk analyses.

VALUE AT RISK ESTIMATION USING EXTREME VALUE THEORY APPROACH IN INDONESIA STOCK EXCHANGE

Extreme Value Theory (EVT) is a method used to identify extreme cases in heavy tail data such as financial time series data. This research aimed to obtain an estimate of stock risk through the EVT approach and compare the accuracy of the two EVT approaches, Block Maxima (BM) and Peaks Over Threshold (POT). The method used to estimate stock risk is VaR with the BM and POT approaches, and the Z statistic is used to compare the accuracy. The data used, and the limitation in this research is daily closing price data for non-cyclical consumer stocks included in LQ45 for the period February 01, 2017, to January 31, 2023. Other research limitations are using weekly blocks or 5 working days in dividing BM blocks, using the percentage method in determining threshold values in the POT approach, and using Maximum Likelihood Estimation (MLE) to estimate EVT parameter estimates. The results of the VaR analysis show that the risk level generated by the POT method is greater than the risk level from BM. The results of backtesting between the two EVT approaches in estimating VaR values show that the POT approach is more accurate than the BM approach.

Genetic analyses unravel the causal association of cytokine levels on lichen simplex chronicus risk: insights from a mendelian randomization study.

Lichen simplex chronicus (LSC) presents a challenge in dermatology due to its elusive pathogenic mechanisms. While associations between circulating inflammatory cytokines and LSC were observed, the definitive causal dynamics remain to be elucidated. Our study used a two-sample Mendelian randomization (MR) approach to investigate causal relationships. We applied a suite of MR methodologies, including IVW, Weighted Median, MR-Egger, Weighted Mode, Simple Mode, MR-PRESSO, and the Steiger test, to ensure robust causal inference. Our analysis confirmed the causal impact of genetically determined cytokine levels on LSC risk, particularly MMP-10 (OR = 0.493, P = 0.004) and DNER (OR = 0.651, P = 0.043) in risk attenuation. We also found a positive causal correlation between GDNF levels (OR = 1.871, P = 0.007) and LSC prevalence. Notably, bidirectional causality was observed between DNER and LSC. Consistency across various MR analyses and sensitivity analyses confirmed the absence of horizontal pleiotropy, validating the causal estimates. This pioneering MR investigation unveils a novel genetically anchored causal relationship between the circulating levels of MMP-10, DNER, and GDNF and LSC risk. Although further validation is requisite, our findings augment the understanding of cytokine mediation in LSC and underscore prospective avenues for research.

Forecasting the level of biological risks of the emergence and spread of infectious and parasitic potato diseases

The article discusses the issues of determining the level of occurrence biological risks, as well as the spread of infectious and parasitic diseases of potato according to the parameters of the transmission mechanisms and routes. Most pathogens are characterized by a high (26.1%) and very high (43.5%) level of risk. It has been established that in the latter group, 75% of infectious and parasitic diseases of potato have a mycotic etiology, 15 – helminthic, 10% – bacterial. There are no pathogens of infectious and parasitic potato diseases of viral etiology in this group. The average score for the very high-risk group is 10.8. In the low-risk group the most of potato diseases pathogens have a bacterial etiology (80%), medium – bacterial (44.5%) and mycotic (33.3%), high – viral (66.6%).

Computed tomography as a predictive tool for ventricular tachycardia

Abstract Background Sudden cardiac death is the main cause of mortality worldwide. It is often linked with ventricular tachycardia (VT). To prevent VT, high-risk patients are typically equipped with intracardiac defibrillators (ICDs). Currently, left ventricular ejection fraction (LVEF) is the standard for determining a patient's risk level. Objective We hypothesized that the use of imaging software analyzing cardiac CT-scans could enhance the detection of patients with an increased risk of VT. Methods and Results In this study, 132 patients with ischemic cardiomyopathy (average age 66.2±11.4 years, with an average LVEF of 36.6±10.3%), all with implanted cardiac devices, underwent CT scans. We developed software to automatically analyze the heart's wall tissue thickness, cardiac fat, and calcification levels (Figure.1.A). A viable cardiac wall thickness of less than 3mm typically indicates a ventricular wall predominantly composed of scar tissue with minimal viable tissue remaining. In contrast, a viable wall thickness of less than 5mm includes regions with more viable tissue and therfore represents the total scar. Over an average follow-up of 6.6 years (79.8 ± 30.5 months) via live telemedicine, we observed that patients with VT had a significant difference in wall thickness ratio (3mm/5mm; no VT 0.31±0.18 vs, VT 0.44±0.18, p&amp;lt;0.01)) and higher calcification (0.10±0.38ml vs. 0.47±1.57ml, p=0.039). The amount of cardiac fat did not significantly differ between the no VT and VT groups (1.14±1.38ml vs.1.21±1.01ml, p=0.771). Logistic regression determined a critical cutoff for wall thickness at a ratio of 0.3 for 3mm and 5mm thickness. Kaplan Meyer analysis contrasted this wall thickness ratio of 0.3 (figure.1.B) against the established LVEF threshold of 35% (figure.1.C) for predicting VT-free survival, revealing a notable disparity favoring wall thickness ratio (p&amp;lt;0.01) over LVEF (p=0.77). Conclusions The findings suggest that a higher proportion of regions of thin viable tissue or dense scar in the total scar is a more effective predictor of VT-free survival than LVEF, potentially improving the identification of patients at risk for sudden cardiac death.Figure. 1

Stroke risk assessment in different atrial fibrillation subtypes: CHA2DS2-VASc score and beyond

Abstract Background Patients with atrial fibrillation (AF) have been known to have an inhomogeneous risk of stroke, with several well-documented risk factors including hypertension, history of stroke, and diabetes mellitus that have been incorporated into the CHA2DS2–VASc score to stratify risk levels. Accumulating evidence has suggested that AF subtype, namely persistent AF and paroxysmal AF, also have an impact on stroke development. Purpose This study focused on the impact of AF subtype on stroke risk in a large, long-term follow-up cohort as to provide insight of the impact on ischemic stroke risks. Such findings may play a role in future ischemic stroke risk stratification in selected patients. Methods A total of 7346 AF patients were followed up for 10 years from January 2010 to December 2020 (mean follow-up time 2.74 years). Among these patients, 2460 (33.5%) had persistent or permanent AF (PerAF) and 4886 (66.5%) had paroxysmal AF (PAF). The study evaluated the risk of ischemic stroke between the two groups using Cox models adjusting for all components of the CHA2DS2–VASc score. Analyses were further stratified into the usage of oral anticoagulation (OAC) or no OAC. Results Comparing AF patients based on subtype, it was found that PerAF patients were older, had a higher prevalence of previous stroke, congestive heart failure, PAD, DM, and were more often prescribed anticoagulants. Univariate analysis found patients with PerAF at a higher risk for ischemic stroke (HR 1.262, p&amp;lt;0.001). The results remained significant after multivariate analysis with factors of the CHA2DS2–VASc score (HR 1.234, p&amp;lt;0.001). After stratifying patients according to anticoagulation prescription, PerAF and PAF patients were found to have similar rates of developing ischemic stroke in patients under DOAC. Conclusions Patients with PerAF have a higher risk of stroke during follow-up independent of components of the CHA2DS2VASc score. In patients with OAC use, there was no difference in stroke risk between AF subtypes.Stroke Risk in OAC-naive patientsStroke Risk in OAC-experienced patients