Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM)

Introduction Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function. Methods Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF). Results This study of 35 women with PPCM (mean age 30.0 ± 5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2–1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD  50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of ≥ 900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05–0.95, P = 0.043) or LVEF (OR 0.20 [95% CI 0.04–0.89], p = 0.035) at follow-up. Conclusions We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of ≥ 900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation

Living with peripartum cardiomyopathy: A statement from the Heart Failure Association and the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

This statement focuses on the fact that women with peripartum cardiomyopathy (PPCM) have a substantial mortality and morbidity rate. Less than 50% of patients have full recovery of their cardiac function within 6 months of diagnosis. Also, patients with recovered cardiac function often suffer from comorbidities, such as hypertension or arrhythmias, which require long-term treatment. This has major implications which extend beyond the life of the patient, as it may also substantially impact her family. Women with a new diagnosis of PPCM should be involved in the decision-making processes regarding therapies, e.g. the recommendation to abstain from breastfeeding, or the use of cardiac implantable electronic devices. Women living with PPCM face the uncertainty of not knowing for some time whether their cardiac function will recover to allow them a near-to-normal life expectancy. This not only impacts their ability to work, which may have financial implications, but may also affect mental health and quality of life for the extended family. Women living with PPCM must be informed that a future pregnancy always carries a substantial risk and, in case of poor cardiac recovery, is associated with a high morbidity and mortality. Patients with PPCM are best managed by an interdisciplinary and multiprofessional approach including e.g. a cardiologist, a gynaecologist, nurses, a psychologist, and social workers. The scope of this document encompasses contemporary challenges and approaches for the management of women diagnosed with PPCM

In Situ Nanoscale Imaging of Struvite Formation during the Dissolution of Natural Brucite: Implications for Phosphorus Recovery from Wastewaters

As phosphorus (P) resources are diminishing, the recovery of this essential nutrient from wastewaters becomes an increasingly interesting option. P-recovery through the controlled crystallization of struvite (MgNH4PO4·6H2O), a potential slow-release fertilizer, is highly attractive, but costly if large amounts of Mg have to be added. In this context, natural Mg-minerals like brucite (Mg(OH)2) could provide more cost-effective Mg-sources compared to high-grade Mg-compounds such as MgCl2. Here we used in situ atomic force microscopy (AFM) to study the interactions of ammonium phosphate solutions with brucite (001) cleavage surfaces. Brucite dissolution was strongly enhanced in the presence of H2PO4(-) ions, most likely due to the formation of negatively charged surface complexes. Simultaneously with brucite dissolution, we directly observed the formation of a new phase that was identified as struvite by Raman spectroscopy. Our results suggest that brucite dissolution and struvite precipitation were coupled at the mineral-fluid interface within a thin fluid boundary layer. An interpretation is proposed where the heterogeneous nucleation and growth of struvite occurs via a particle-mediated process involving the formation of primary nanoparticles, followed by their continuous aggregation, fusion and possible transformation to crystalline struvite. These observations have implications for the feasibility of using brucite in phosphorus recovery processes

Particle-Mediated Nucleation Pathways Are Imprinted in the Internal Structure of Calcium Sulfate Single Crystals

Calcium sulfate minerals are found in nature as three hydrates: gypsum (CaSO4·2H2O), bassanite (CaSO4·0.5H2O), and anhydrite (CaSO4). Due to their relevance in natural and industrial processes, the formation pathways of calcium sulfates from aqueous solution have been the subject of intensive research, and there is a growing body of literature, suggesting that calcium sulfates form through nonclassical nanoparticle-mediated crystallization processes. We showed earlier (Stawski et al. Nat. Commun.2016, 7, 11177) that at the early stages in the precipitation reaction, calcium sulfate nanocrystals nucleate through the reorganization and coalescence of aggregates rather than through classical unit addition. Here, we used low-dose dark field (DF) transmission electron microscopy (TEM) and electron diffraction and document that these restructuring processes do not continue until a final near-perfectly homogeneous single crystal is obtained. Instead, we show that the growth process yields a final imperfect mesocrystal with an overall morphology resembling that of a single crystal, yet composed of smaller nanodomains. Our data reveal that organic-free calcium sulfate mesocrystals grown by a particle mediated-pathway may preserve in the final crystal structure a “memory” or “imprint” of their nonclassical nucleation process, something that has been overlooked until now. Furthermore, the nanoscale misalignment of the structural subunits within these crystals might propagate through the length-scales, which is potentially expressed macroscopically as misaligned zones/domains in large single crystals. This is akin to observations in some of the giant crystals from the Naica Mine, Chihuahua, Mexico

The prognostic significance of the 12-lead ECG in peripartum cardiomyopathy

Background: Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure, which appears in previously healthy women towards the end of pregnancy or within five months following delivery. Although the ECG is widely used in clinical practice, its prognostic value has not been established in PPCM. Methods: We analysed 12-lead ECGs of patients with PPCM, taken at index presentation and follow-up visits at 6 and 12 months. Poor outcome was determined by the composite endpoint of death, readmission, NYHA functional class III/IV or left ventricular ejection fraction (LVEF) of ≤35% at follow-up. Results: This cohort of 66 patients had a median age of 28.59 (IQR 25.43–32.19). The median LVEF at presentation (33%, IQR 25–40) improved significantly at follow-up (LVEF 49%, IQR 38–55, P < 0.001 at 6 months; 52% IQR 38–57, P = 0.001 at 12 months). Poor outcome occurred in 27.91% at 6 months and 41.18% at 1 year. Whereas sinus tachycardia at baseline was an independent predictor of poor outcome at 12 months (OR 6.56, 95% CI 1.17–20.41, P = 0.030), sinus arrhythmia was associated with event free survival (log rank P = 0.013). T wave inversion was associated with an LVEF ≤35% at presentation (P = 0.038), but did not predict poor outcome. A prolonged QTc interval at presentation (found in almost half of the cohort) was an independent predictor of poor outcome at 6 months (OR 6.34, 95% CI 1.06–37.80, P = 0.043). Conclusion(s): A prolonged QTc and sinus tachycardia at baseline were independent predictors of poor outcome in PPCM at 6 months and 1 year respectively

Molecular View on Supramolecular Chain and Association Dynamics

The chain and association dynamics of supramolecular polymer ensembles decisively determines their properties. Using neutron spin echo (NSE) spectroscopy we present molecular insight into the space and time evolution of this dynamics. Studying a well characterized ensemble of linearly associating telechelic poly(ethylene glycol) melts carrying triple H-bonding end groups, we show that H-bond breaking significantly impacts the mode spectrum of the associates. The breaking affects the mode contributions and not the relaxation times as was assumed previously. NSE spectra directly reveal the so far intangible H-bond lifetimes in the supramolecular melt and demonstrate that for both the microscopic and the macroscopic dynamics of the supramolecular ensemble the instantaneous average of the M-w distribution governs the system response at least as long as the Rouse picture applies