{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T12:01:31Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 23.5, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0957d-5d0c-7152-912b-03e8e6cb4ca6\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: peripartum cardiomyopathy\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch", "usd": 0.0, "recall": true }, "codex": { "seconds": 75.3, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0957d-5d1c-7a70-8852-2d52b218f851\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: peripartum cardiomyopathy\nRegistry id: vr.tr.peripartum-cardiomyopathy\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folde" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:42:16+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:29+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q2938089", "registryId": "vr.tr.peripartum-cardiomyopathy", "name": "peripartum cardiomyopathy", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q2938089/", "model": { "registry_id": "vr.tr.peripartum-cardiomyopathy", "name": "peripartum cardiomyopathy", "purpose": "Enable an agent to recognise suspected peripartum cardiomyopathy, record diagnostic uncertainty and cardiac trajectory, and support clinician-led decisions across pregnancy, postpartum recovery and future pregnancies.", "definition": "Peripartum cardiomyopathy is a cardiomyopathy presenting with heart failure due to left ventricular systolic dysfunction, usually with an ejection fraction below 45%, towards the end of pregnancy or in the months following delivery, without another identifiable cause.", "scope_statement": "This model owns the pregnancy-associated cardiomyopathy episode represented by vr.tr.peripartum-cardiomyopathy, including attribution, severity, treatment constraints and longitudinal outcomes; it models a clinical condition despite its XCT / XCT.STA registry placement.", "in_scope": [ "Timing of cardiac symptoms and dysfunction relative to pregnancy and its end", "Evidence supporting peripartum cardiomyopathy and assessment of alternative causes", "Ventricular function, congestion, haemodynamic instability and cardiac complications", "Treatment decisions constrained by pregnancy, lactation and maternal condition", "Recovery, persistent dysfunction and subsequent-pregnancy assessment" ], "out_of_scope": [ "General pregnancy physiology and routine maternity care", "Independent models of pre-eclampsia, pulmonary embolism and coronary disease", "Pre-existing cardiomyopathy outside its relationship to the presenting episode", "Complete drug monographs and generic heart-failure treatment protocols", "Independent fetal, neonatal and inherited-variant models" ], "distinguishing_features": [ "Require a compatible pregnancy-related timeline, heart-failure presentation and left ventricular ejection fraction below 45%, with no alternative explanatory cause; record the definition used. [2025 ESC guidance](https://www.escardio.org/static-file/Escardio/Guidelines/Products/Slide%20sets/2025/2025%20official%20slides_Pregnancy.pdf)", "Distinguish ordinary pregnancy-related breathlessness or swelling from cardiac failure using objective assessment rather than symptoms alone. [AHA assessment guidance](https://professional.heart.org/en/science-news/heart-failure-occurring-in-the-perinatal-period/top-things-to-know)", "Check prior cardiac records before distinguishing newly recognised peripartum disease from established cardiomyopathy presenting during pregnancy.", "Assess whether hypertensive disease, coronary injury, pulmonary embolism or another process explains the presentation; pregnancy association alone does not settle attribution." ], "characteristics": [ { "name": "Pregnancy-relative onset", "kind": "measurement", "unit_or_values": "Gestational weeks at onset or days after pregnancy ended, with date uncertainty", "why_it_matters": "Separates symptom onset, detection and diagnosis when assessing the temporal boundary." }, { "name": "Diagnostic adjudication", "kind": "state", "unit_or_values": "Suspected | clinician-supported | disputed | alternative diagnosis established", "why_it_matters": "Prevents incomplete exclusion work from becoming a definitive disease label." }, { "name": "Left ventricular ejection fraction", "kind": "measurement", "unit_or_values": "%, with date, modality and measurement quality", "why_it_matters": "Supports recognition and comparison of dysfunction across the episode." }, { "name": "Ventricular dimensions and right ventricular function", "kind": "measurement", "unit_or_values": "LV dimensions in mm or indexed volumes in mL/m²; RV assessment with method", "why_it_matters": "Describes the cardiac phenotype beyond a single ejection-fraction value." }, { "name": "Clinical stability", "kind": "state", "unit_or_values": "Stable | congested | hypoperfused | shock | unknown, with supporting observations", "why_it_matters": "Makes the urgency of clinical review explicit." }, { "name": "Pregnancy and lactation phase", "kind": "category", "unit_or_values": "Pregnant with gestational age | postpartum lactating | postpartum not lactating | other documented state", "why_it_matters": "Provides context for medication and procedural decisions." }, { "name": "Cardiac complications", "kind": "state", "unit_or_values": "Dated evidence of arrhythmia, intracardiac thrombus, embolic event or mechanical support; absent or unassessed distinguished", "why_it_matters": "Connects complications to episode severity and treatment review." }, { "name": "Familial or genetic cardiomyopathy context", "kind": "relation", "unit_or_values": "Links to family history, genetic assessment and interpreted variant records", "why_it_matters": "Allows inherited susceptibility to be considered without automatically replacing the clinical diagnosis." }, { "name": "Recovery trajectory", "kind": "state", "unit_or_values": "Improving | persistent dysfunction | documented functional recovery | deterioration after recovery | indeterminate", "why_it_matters": "Keeps recovery tied to dated evidence and an explicit definition." } ], "affordances": [ "Assemble a pregnancy-relative timeline and identify missing diagnostic evidence", "Flag documented instability for urgent clinician assessment", "Compare serial cardiac measurements and identify apparent recovery or deterioration", "Surface treatment decisions requiring pregnancy or lactation compatibility review", "Prepare multidisciplinary follow-up and subsequent-pregnancy counselling records" ], "agent_conduct": { "may": [ "Explain the condition in general terms from reputable medical sources.", "Urge a pregnant or recently delivered person with breathlessness, swelling or chest pain to seek care urgently." ], "must_not": [ "Dismiss breathlessness or swelling in late pregnancy or after birth as normal.", "Diagnose the condition or advise on medicines for a specific person.", "Advise on future pregnancies or breastfeeding for a specific person.", "Disclose a person's diagnosis without consent." ], "requires_human": [ "Decisions on treatment, delivery timing or future pregnancies." ] }, "ethics": { "considerations": [ "Symptoms are easily confused with normal pregnancy, and delay can be fatal.", "Mothers face choices about future pregnancies that are theirs to make." ], "affected_parties": [ "Pregnant and postpartum women", "Newborns and families", "Partners" ] }, "owners": { "steward": "Nobody owns the condition; patients and their clinicians answer for care.", "master_systems": [] }, "failure_modes_and_hazards": [ "Heart failure, dangerous heart rhythms and blood clots.", "Can recur in later pregnancies." ], "standards_and_regulation": [ "International Classification of Diseases (ICD-11), World Health Organization." ], "what_it_is_for": [ "Peripartum cardiomyopathy is encountered in maternity, emergency and cardiology care when heart failure develops near the end of pregnancy or after delivery.", "The diagnosis informs clinician-led assessment, follow-up of cardiac recovery and discussions about subsequent pregnancies." ], "facets_not_applicable": { "recognition": "Peripartum cardiomyopathy has no distinctive visual appearance, and identification requires clinical assessment and cardiac investigations." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q2938089: peripartum cardiomyopathy", "url": "https://www.wikidata.org/wiki/Q2938089", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Peripartum cardiomyopathy", "url": "https://en.wikipedia.org/wiki/Peripartum_cardiomyopathy", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "episode-recognition-and-attribution", "name": "Episode recognition and attribution", "description": "Establish whether the episode fits peripartum cardiomyopathy and how confidently that attribution is supported.", "rationale": "Pregnancy-associated symptoms and cardiac dysfunction require both temporal interpretation and assessment of competing explanations.", "layers": [ { "id": "pregnancy-relative-timeline", "name": "Pregnancy-relative timeline", "description": "Anchor symptoms, investigations and diagnosis to the relevant pregnancy.", "findings": [ { "id": "onset-and-definition-fit", "name": "Onset and definition fit", "description": "Record actual onset separately from first presentation, and identify the diagnostic definition applied rather than imposing an undocumented time cutoff.", "questions": [ { "text": "When did symptoms and objective ventricular dysfunction first appear relative to delivery, miscarriage or termination?", "kind": "measurement", "id": "onset-and-definition-fit-q01" }, { "text": "Which published definition and temporal window did the diagnosing team apply?", "kind": "definition", "id": "onset-and-definition-fit-q02" } ] } ] }, { "id": "causal-adjudication", "name": "Causal adjudication", "description": "Connect the diagnosis to prior cardiac status and the differential assessment.", "findings": [ { "id": "alternative-cause-assessment", "name": "Alternative cause assessment", "description": "Preserve supporting, conflicting and missing evidence for each credible alternative explanation.", "questions": [ { "text": "What pre-pregnancy history or imaging establishes whether cardiac dysfunction was already present?", "kind": "provenance", "id": "alternative-cause-assessment-q01" }, { "text": "Which alternatives were assessed, and does pre-eclampsia represent a coexisting condition or the principal explanation for this episode?", "kind": "boundary", "id": "alternative-cause-assessment-q02" } ] } ] } ] }, { "id": "cardiac-phenotype-and-urgency", "name": "Cardiac phenotype and urgency", "description": "Represent objective dysfunction and the immediate clinical state.", "rationale": "An episode label alone cannot establish whether a patient is stable or requires emergency escalation.", "layers": [ { "id": "ventricular-assessment", "name": "Ventricular assessment", "description": "Capture the initial cardiac phenotype with interpretable measurements.", "findings": [ { "id": "baseline-cardiac-function", "name": "Baseline cardiac function", "description": "Retain LVEF, ventricular dimensions, right ventricular findings and relevant imaging observations with acquisition context.", "questions": [ { "text": "What are the earliest reliable LVEF, LV dimensions and RV function measurements?", "kind": "measurement", "id": "baseline-cardiac-function-q01" }, { "text": "Which imaging report, date and technical limitations support those values?", "kind": "provenance", "id": "baseline-cardiac-function-q02" } ] } ] }, { "id": "acute-deterioration", "name": "Acute deterioration", "description": "Connect symptoms and observations to clinician-assessed urgency.", "findings": [ { "id": "congestion-and-perfusion", "name": "Congestion and perfusion", "description": "Distinguish symptom burden from documented pulmonary congestion, impaired oxygenation or circulatory compromise.", "questions": [ { "text": "What do blood pressure, oxygen saturation, examination and organ-perfusion observations show at this assessment?", "kind": "measurement", "id": "congestion-and-perfusion-q01" }, { "text": "Do current findings require emergency assessment, admission or transfer under the treating team's escalation protocol?", "kind": "action", "id": "congestion-and-perfusion-q02" } ] } ] } ] }, { "id": "pregnancy-constrained-care", "name": "Pregnancy-constrained care", "description": "Record how reproductive phase and clinical severity shape treatment decisions.", "rationale": "Care must connect cardiac needs to pregnancy, lactation and coordinated obstetric decisions.", "layers": [ { "id": "therapy-context", "name": "Therapy context", "description": "Document phase-specific treatment selection and reassessment.", "findings": [ { "id": "medication-and-lactation-review", "name": "Medication and lactation review", "description": "For each proposed treatment, capture indication, pregnancy or breastfeeding review, monitoring and clinician responsibility.", "questions": [ { "text": "Which therapies require initiation, substitution or reassessment given the current gestational or lactation state?", "kind": "action", "id": "medication-and-lactation-review-q01" }, { "text": "If bromocriptine is considered, what evidence, lactation implications and associated anticoagulation plan underpin the specialist decision?", "kind": "action", "id": "medication-and-lactation-review-q02" } ] } ] }, { "id": "obstetric-cardiac-coordination", "name": "Obstetric-cardiac coordination", "description": "Link cardiac status to delivery planning and transitions between care settings.", "findings": [ { "id": "shared-care-plan", "name": "Shared care plan", "description": "Record the agreed responsibilities and contingencies of cardiology, obstetrics and anaesthesia.", "questions": [ { "text": "If pregnancy is ongoing, how does current cardiac status inform the documented timing, location and mode-of-delivery plan?", "kind": "action", "id": "shared-care-plan-q01" }, { "text": "Who owns cardiac monitoring and treatment review during delivery, early postpartum care and discharge?", "kind": "provenance", "id": "shared-care-plan-q02" } ] } ] } ] }, { "id": "complications-and-escalation", "name": "Complications and escalation", "description": "Track cardiac complications and the decisions they trigger.", "rationale": "Thrombotic events, arrhythmias and refractory deterioration require distinct evidence and specialist decisions.", "layers": [ { "id": "thrombotic-assessment", "name": "Thrombotic assessment", "description": "Separate established thrombosis from preventive treatment considerations.", "findings": [ { "id": "thrombus-and-anticoagulation-context", "name": "Thrombus and anticoagulation context", "description": "Connect imaging or event evidence to the stated anticoagulation indication and competing bleeding considerations.", "questions": [ { "text": "Is intracardiac thrombus or an embolic event documented, suspected or unassessed?", "kind": "measurement", "id": "thrombus-and-anticoagulation-context-q01" }, { "text": "What indication, delivery-related bleeding considerations and review date support the anticoagulation decision?", "kind": "action", "id": "thrombus-and-anticoagulation-context-q02" } ] } ] }, { "id": "electrical-and-circulatory-rescue", "name": "Electrical and circulatory rescue", "description": "Record arrhythmic events and advanced-support decisions in the context of potential recovery.", "findings": [ { "id": "specialist-escalation-decision", "name": "Specialist escalation decision", "description": "Preserve the evidence and reassessment plan behind rhythm protection, mechanical support or advanced heart-failure referral.", "questions": [ { "text": "What documented arrhythmias, syncope or persistent haemodynamic compromise prompted specialist review?", "kind": "provenance", "id": "specialist-escalation-decision-q01" }, { "text": "What temporary or durable intervention was selected, and when will its need be reassessed against cardiac recovery?", "kind": "action", "id": "specialist-escalation-decision-q02" } ] } ] } ] }, { "id": "recovery-and-reproductive-future", "name": "Recovery and reproductive future", "description": "Follow the episode beyond initial stabilisation and support future reproductive decisions.", "rationale": "Symptom improvement, measured recovery and future-pregnancy assessment are separate judgements.", "layers": [ { "id": "longitudinal-recovery", "name": "Longitudinal recovery", "description": "Evaluate change using serial measurements and explicit recovery criteria.", "findings": [ { "id": "recovery-evidence-and-treatment-review", "name": "Recovery evidence and treatment review", "description": "Track cardiac function and symptoms over time while preserving treatment exposure and follow-up gaps.", "questions": [ { "text": "Which dated findings satisfy the team's recovery definition, and are measurements comparable across visits?", "kind": "measurement", "id": "recovery-evidence-and-treatment-review-q01" }, { "text": "What clinician-approved plan governs continued therapy, any withdrawal and surveillance for deterioration?", "kind": "action", "id": "recovery-evidence-and-treatment-review-q02" } ] } ] }, { "id": "subsequent-pregnancy-assessment", "name": "Subsequent-pregnancy assessment", "description": "Connect reproductive preferences to current cardiac status and individualised counselling.", "findings": [ { "id": "preconception-risk-and-preferences", "name": "Preconception risk and preferences", "description": "Record current function, residual uncertainty and the patient's preferences; incomplete recovery is associated with greater risk in future pregnancies. [AHA patient guidance](https://www.heart.org/-/media/GRFW-Files/Know-Your-Risk/Maternal-Health/Peripartum_Cardiomyopathy.pdf)", "questions": [ { "text": "What current cardiac assessment and episode history support the specialist's subsequent-pregnancy risk discussion?", "kind": "provenance", "id": "preconception-risk-and-preferences-q01" }, { "text": "What reproductive preferences, contraception choices and preconception or pregnancy monitoring plan were agreed?", "kind": "action", "id": "preconception-risk-and-preferences-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Recalled knowledge only; no sources were consulted.", "Timing definitions vary: older criteria specified the last month of pregnancy through five months postpartum, while broader definitions avoid a rigid window.", "Verify current guideline recommendations, coding details and regional incidence estimates before formal publication or clinical use." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "O90.3", "note": "Peripartum cardiomyopathy; national coding modifications and exclusions should be checked." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "European Society of Cardiology guidelines on cardiovascular disease during pregnancy address diagnosis, treatment and subsequent pregnancy counselling.", "Heart Failure Association of the European Society of Cardiology position statements address peripartum cardiomyopathy.", "AHA/ACC/HFSA guidelines for the management of heart failure provide relevant treatment principles, subject to pregnancy and lactation restrictions." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Recognition of otherwise unexplained heart failure during late pregnancy or after delivery.", "Coordination of cardiology, obstetric and anaesthetic care.", "Serial assessment of ventricular recovery and persistent cardiac dysfunction.", "Counselling about recurrence and deterioration risks in subsequent pregnancies.", "Evaluation for inherited cardiomyopathy susceptibility when clinically appropriate." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Left ventricular ejection fraction", "typical_range": "Usually below 45% at diagnosis; this is a diagnostic threshold, not a population reference range.", "unit": "%" }, { "quantity": "BNP or NT-proBNP concentration", "typical_range": "Often elevated; there is no single disease-specific diagnostic range.", "unit": "pg/mL" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Delayed diagnosis because breathlessness, fatigue and oedema may be attributed to normal pregnancy or postpartum changes.", "Acute decompensated heart failure, pulmonary oedema and cardiogenic shock.", "Ventricular arrhythmias and sudden cardiac death.", "Intracardiac thrombus and systemic thromboembolism.", "Persistent ventricular dysfunction or relapse, including during subsequent pregnancies despite apparent recovery." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Reported incidence varies substantially across populations and regions; ascertainment and access to diagnosis affect estimates.", "Access to echocardiography, specialist maternal cardiac care and advanced heart failure support affects recognition and outcomes." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Dilated cardiomyopathy", "difference": "Peripartum cardiomyopathy is distinguished by its pregnancy-associated presentation and exclusion of another cause; ventricular dilation is not required, and genetic susceptibility can overlap." }, { "name": "Pre-eclampsia-associated heart failure", "difference": "Hypertension and related haemodynamic dysfunction may explain heart failure; peripartum cardiomyopathy requires otherwise unexplained left ventricular systolic dysfunction, although the conditions can coexist." }, { "name": "Myocarditis", "difference": "Evidence supporting myocardial inflammation as the cause may establish an alternative diagnosis; presentation alone does not reliably distinguish them." }, { "name": "Takotsubo syndrome", "difference": "Typically features a transient regional ventricular contraction pattern, whereas peripartum cardiomyopathy more commonly produces global left ventricular systolic dysfunction." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of peripartum cardiomyopathy this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "How should presentations outside traditional postpartum time windows be classified across competing definitions?", "How should genetic susceptibility or previously unrecognised dilated cardiomyopathy alter attribution without erasing a pregnancy-associated episode?", "Which patients benefit from bromocriptine, and how should uncertain benefit be weighed against lactation implications and anticoagulation requirements?", "What combination of functional, imaging and biomarker evidence establishes durable recovery and supports safe treatment reduction?", "How accurately can subsequent-pregnancy deterioration be predicted after apparent recovery, and how transferable are available estimates across populations and care settings?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 28 } }