Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety

BACKGROUND Fat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m$^{2}$] and normal-weight controls (BMI <30 kg/m$^{2}$) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM. MATERIALS AND METHODS Patients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61-90 and days 1-90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls. RESULTS The average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P < 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups. CONCLUSION Although increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was >0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220

Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety

BackgroundFat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m2] and normal-weight controls (BMI &lt;30 kg/m2) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM.Materials and methodsPatients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61–90 and days 1–90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls.ResultsThe average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P &lt; 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups.ConclusionAlthough increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was &gt;0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220

Isolated multiple pericardial hydatid cysts in an asymptomatic patient: Role of the CMR

Hydatid cysts primarily affect the liver and secondary involvement may be seen in almost any anatomic location.&nbsp;We describe the unusual pericardial location of the Echinococcus cysts in an asymptomatic patient with suggestive cardiac magnetic resonance imaging

Economic capital management for insurance companies using conditional value at risk and a copula approach

The loss ratio (LR) for insurance companies is defined as the ratio of incurred claims and earned premiums for a specified class of insurance (CoI). The company may estimate then its capital requirement for that particular CoI by using Value at Risk (VaR) or conditional VaR (CVaR) of the loss ratio distribution at a specified probability value. The overall objective of the company is to evaluate the aggregate capital requirement through a weighted sum of marginal capital requirements for all the classes of insurance. Nevertheless, this procedure may tend to over-estimate the aggregate capital requirement because it does not take into consideration the real dependence amongst the different classes of insurance. In other words, perfect dependence does not allow considering diversification effects. In this paper, we present a model which permits to take into consideration real correlations of the several CoIs. Thanks to copula functions, we are able to generate (by Monte Carlo simulations) correlated loss ratios with known marginal distributions. This approach is described through a numerical example that used data collected from some of the most important Italian non life insurance companies. We show then the diversification benefit thus obtained. We conclude the paper building an efficient frontier on the plane LR - CVaR; the efficient frontier may be considered a useful tool to manage the global company risk

ECONOMIC CAPITAL MANAGEMENT FOR INSURANCE COMPANIES USING CONDITIONAL VALUE AT RISK AND A COPULA APPROACH

The loss ratio (LR) for insurance companies is defined as the ratio of incurred claims and earned premiums for a specified class of insurance (CoI). The company may estimate then its capital requirement for that particular CoI by using Value at Risk (VaR) or conditional VaR (CVaR) of the loss ratio distribution at a specified probability value. The overall objective of the company is to evaluate the aggregate capital requirement through a weighted sum of marginal capital requirements for all the classes of insurance. Nevertheless, this procedure may tend to over-estimate the aggregate capital requirement because it does not take into consideration the real dependence amongst the different classes of insurance. In other words, perfect dependence does not allow considering diversification effects. In this paper, we present a model which permits to take into consideration real correlations of the several CoIs. Thanks to copula functions, we are able to generate (by Monte Carlo simulations) correlated loss ratios with known marginal distributions. This approach is described through a numerical example that used data collected from some of the most important Italian non life insurance companies. We show then the diversification benefit thus obtained. We conclude the paper building an efficient frontier on the plane LR - CVaR; the efficient frontier may be considered a useful tool to manage the global company risk.non life insurance; loss ratio; copula functions; capital requirement; Monte Carlo simulation; risk measures; efficient frontier.

The Telecardiology Revolution: From Emergency Management to Daily Clinical Practice

Aims: Telecardiology is one of the most widespread applications of telemedicine. We aimed to report the design and development of a telecardiology system in the sanitary district of Cosenza, one of the largest in Italy, with a complex orography, and healthcare reorganization needs, for the management of the emergency network and daily clinical practice. Methods: Our telecardiology network connects 8 hospitals, 9 first aid centers, 20 local 118-EMS stations, 1 helicopter station, 8 hospital emergency departments, 59 hospital departments, and 3 catheterization laboratories. All data are centralized on a dedicated server, accessible from any location for real-time assessment. The quality, source, and timing of the electrocardiograms transmitted were evaluated. Results: From October 2015 to December 2019, a total of 389,970 ECGs were transmitted. The quality of ECGs was optimal in 52%, acceptable in 42%, and poor in 6% of the cases. The number of poor-quality ECGs was only 3% in the last 2 years. Out of the total, 145,097 (37.2%) were transmitted from the emergency departments and 5318 (1.4%) from the 118-EMS. Of interest, a sizable part of the ECG was related to routine clinical practice, comprising 110,556 (28.3%) from the cardiology department and 79,256 (20.3%) from other noncardiovascular departments. Finally, the average reporting time was significantly decreased compared to reporting times without a telecardiology system (5&ndash;10 vs. 45&ndash;90 min). Conclusion: Our telecardiology system provides efficient cardiology assistance for all types, settings, and phases of cardiovascular diseases

The Telecardiology Revolution: From Emergency Management to Daily Clinical Practice

Aims: Telecardiology is one of the most widespread applications of telemedicine. We aimed to report the design and development of a telecardiology system in the sanitary district of Cosenza, one of the largest in Italy, with a complex orography, and healthcare reorganization needs, for the management of the emergency network and daily clinical practice. Methods: Our telecardiology network connects 8 hospitals, 9 first aid centers, 20 local 118-EMS stations, 1 helicopter station, 8 hospital emergency departments, 59 hospital departments, and 3 catheterization laboratories. All data are centralized on a dedicated server, accessible from any location for real-time assessment. The quality, source, and timing of the electrocardiograms transmitted were evaluated. Results: From October 2015 to December 2019, a total of 389,970 ECGs were transmitted. The quality of ECGs was optimal in 52%, acceptable in 42%, and poor in 6% of the cases. The number of poor-quality ECGs was only 3% in the last 2 years. Out of the total, 145,097 (37.2%) were transmitted from the emergency departments and 5318 (1.4%) from the 118-EMS. Of interest, a sizable part of the ECG was related to routine clinical practice, comprising 110,556 (28.3%) from the cardiology department and 79,256 (20.3%) from other noncardiovascular departments. Finally, the average reporting time was significantly decreased compared to reporting times without a telecardiology system (5–10 vs. 45–90 min). Conclusion: Our telecardiology system provides efficient cardiology assistance for all types, settings, and phases of cardiovascular diseases

Role of cardiovascular imaging in cardiac resynchronization therapy: A literature review

Cardiac resynchronization therapy (CRT) is an established treatment in patients with symptomatic drug-refractory heart failure and broad QRS complex on the surface ECG. Despite the presence of either mechanical dyssynchrony or viable myocardium at the site where delivering left ventricular pacing being necessary conditions for a successfulCRT, their direct assessment by techniques of cardiovascular imaging, though feasible, is not recommended in clinical practice by the current guidelines. Indeed, even though there is growing body of data providing evidence of the additional value of an image-based approach as compared with routine approach in improving response to CRT, these results should be confirmed in prospective and large multicentre trials before their impact on CRT guidelines is considered