Acute right ventricular failure caused by extensive cardiac infiltration of T-cell acute lymphoblastic leukaemia
Bibliographic record
Abstract
A 25-year-old man presented with shortness of breath, jugular vein distention, and peripheral oedema indicating acute heart failure. Electrocardiography demonstrated incomplete right bundle branch block (RBBB; Panel A). Transthoracic echocardiography (TTE) revealed a hypoechogenic, bulky mass filling the right atrium (38 × 68 × 49 mm), a thickened hypoechogenic septal wall (32 mm), impaired right ventricular function and circular pericardial effusion (Panels B–D; Supplementary data online, Videos S1–S3). Computed tomography (CT) confirmed right heart infiltration (Panel G) and a mediastinal mass, highly suspicious of lymphoma. Bone marrow morphology, flow cytometry, and molecular profiling secured the diagnosis of precursor T-cell acute lymphoblastic leukaemia with cardiac infiltration.(Arrows show highligthing of the described intra-cardiac mass). The patient received immediate prophase treatment (dexamethasone and cyclophosphamide), followed by remission induction therapy (daunorubicin, vincristine, p-asparaginase and dexamethasone), according to the GMALL protocol 08/2013. One week after treatment initiation, clinical signs of heart failure and the RBBB had vanished. In both TTE (Panels E and F) and CT (Panel H), the right atrial mass was gone, with normalization of septal wall and right ventricular function. Subsequent salvage treatment and allogeneic stem cell transplantation induced molecular disease-free survival with good performance status at the last follow-up 7 months after initial diagnosis. No further cardiac involvement was registered. Cardiac infiltration of the myocardium by acute T-cell lymphoblastic leukaemia represents a very rare event. Even in cases with a considerable extent as in the index patient of this case, the disease may respond rapidly to chemotherapy, allowing reversion of cardiac constraints and high-dose treatment in definitive, curative intent. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".