The clinical and prognostic value of late Gadolinium enhancement imaging in heart failure with mid-range and preserved ejection fraction

Heart failure (HF) with mid-range or preserved ejection fraction (HFmrEF; HFpEF) is a heterogeneous disorder that could benefit from strategies to identify subpopulations at increased risk. We tested the hypothesis that HFmrEF and HFpEF patients with myocardial scars detected with late gadolinium enhancement (LGE) are at increased risk for all-cause mortality. Symptomatic HF patients with left ventricular ejection fraction (LVEF) > 40%, who underwent cardiac magnetic resonance (CMR) imaging were included. The presence of myocardial LGE lesions was visually assessed. T1 mapping was performed to calculate extracellular volume (ECV). Multivariable logistic regression analyses were used to determine associations between clinical characteristics and LGE. Cox regression analyses were used to assess the association between LGE and all-cause mortality. A total of 110 consecutive patients were included (mean age 71 +/- 10 years, 49% women, median N-terminal brain natriuretic peptide (NT-proBNP) 1259 pg/ml). LGE lesions were detected in 37 (34%) patients. Previous myocardial infarction and increased LV mass index were strong and independent predictors for the presence of LGE (odds ratio 6.32, 95% confidence interval (CI) 2.07-19.31, p = 0.001 and 1.68 (1.03-2.73), p = 0.04, respectively). ECV was increased in patients with LGE lesions compared to those without (28.6 vs. 26.6%, p = 0.04). The presence of LGE lesions was associated with a fivefold increase in the incidence of all-cause mortality (hazards ratio 5.3, CI 1.5-18.1, p = 0.009), independent of age, sex, New York Heart Association (NYHA) functional class, NT-proBNP, LGE mass and LVEF. Myocardial scarring on CMR is associated with increased mortality in HF patients with LVEF > 40% and may aid in selecting a subpopulation at increased risk

Nature development in degraded landscapes: How pioneer bioturbators and water level control soil subsidence, nutrient chemistry and greenhouse gas emission

The restoration of degraded ecosystems and landscapes is challenging, because returning to the original state is often socio-economically unfeasible. A novel approach is to construct new ecosystems to improve the functioning of degraded landscapes. However, the development of novel ecosystems is largely driven by the pre-construction hydrogeophysical and ecological conditions of the soil. In Lake Markermeer, a deteriorating freshwater lake in the Netherlands, a large archipelago is currently being constructed to boost the ecological functioning of the lake. Hence, islands – with wetlands and with more elevated and dryer areas – have been created to sustain biodiversity and key biogeochemical functions such as nutrient cycling. The islands are constructed from lake-bottom sediments. To study how two potentially important drivers, water level and bioturbation, affect soil characteristics in a novel wetland ecosystem, we experimentally tested the effects of water level (-30, -10 and 5 cm), and bioturbation by earthworms (Lumbricus rubellus) and Tubifex spp. in a microcosm experiment. We demonstrate that a high water level prevents soil subsidence, soil crack formation and carbon dioxide (CO2) emissions, and affects nitrogen cycling. In dryer soils, the presence of earthworms strongly increases CO2 emissions next to reducing soil crack formation, while Tubifex spp. in wetter soils hardly affect soil characteristics. Our findings highlight the important roles of both water level and bioturbation for the functioning of novel soils, which likely affects vegetation development in novel ecosystems. This knowledge can be used to aid the construction and nature development of novel wetlands

Nature development in degraded landscapes: How pioneer bioturbators and water level control soil subsidence, nutrient chemistry and greenhouse gas emission

The restoration of degraded ecosystems and landscapes is challenging, because returning to the original state is often socio-economically unfeasible. A novel approach is to construct new ecosystems to improve the functioning of degraded landscapes. However, the development of novel ecosystems is largely driven by the pre-construction hydrogeophysical and ecological conditions of the soil. In Lake Markermeer, a deteriorating freshwater lake in the Netherlands, a large archipelago is currently being constructed to boost the ecological functioning of the lake. Hence, islands – with wetlands and with more elevated and dryer areas – have been created to sustain biodiversity and key biogeochemical functions such as nutrient cycling. The islands are constructed from lake-bottom sediments. To study how two potentially important drivers, water level and bioturbation, affect soil characteristics in a novel wetland ecosystem, we experimentally tested the effects of water level (-30, -10 and 5 cm), and bioturbation by earthworms (Lumbricus rubellus) and Tubifex spp. in a microcosm experiment. We demonstrate that a high water level prevents soil subsidence, soil crack formation and carbon dioxide (CO2) emissions, and affects nitrogen cycling. In dryer soils, the presence of earthworms strongly increases CO2 emissions next to reducing soil crack formation, while Tubifex spp. in wetter soils hardly affect soil characteristics. Our findings highlight the important roles of both water level and bioturbation for the functioning of novel soils, which likely affects vegetation development in novel ecosystems. This knowledge can be used to aid the construction and nature development of novel wetlands