Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Primary cardiac angiosarcoma is an extremely rare and aggressive malignancy with a poor prognosis. Herein, we describe a case of left atrial angiosarcoma presenting with acute respiratory failure that required emergency surgical intervention, highlighting the condition's diagnostic and therapeutic challenges. CASE PRESENTATION: On routine chest radiography, a mass shadow in the right lower lung field was detected in a 75-year-old male, initially suspected to be lung cancer or a pulmonary abscess. During hospitalization for diagnostic workup, the patient's respiratory function suddenly deteriorated upon mobilization. In addition, contrast-enhanced CT revealed a large intracardiac mass occupying the left atrium. Following emergent intubation for severe hypoxemia, he was transferred to our institution for surgical intervention. Laboratory findings showed elevated inflammatory markers (white blood cells, 22850/μL; C-reactive protein, 15.9 mg/dL), coagulopathy (D-dimer, 18.67 μg/mL), and severe metabolic acidosis (pH 7.15; lactate, 31 mmol/L). Transesophageal echocardiography confirmed a large mass filling the left atrium, nearly incarcerated in the mitral valve orifice. Subsequently, emergency surgery was performed under cardiopulmonary bypass. Through a right atrial and transseptal approach, the friable tumor filling the left atrium was removed. However, the right lower pulmonary vein inlet showed extensive tumor involvement with residual attachment. Despite extensive resection and thorough cavity irrigation, complete resection could not be definitively confirmed. Initially, the patient regained consciousness without neurological deficits and was successfully weaned from mechanical ventilation on POD 6. However, severe tachypnea and copious bloody sputum production developed on POD 7, necessitating reintubation and tracheostomy. Despite hemodynamic stability, he experienced progressive type II respiratory failure, which caused his death on POD 14. Histopathological analysis revealed positivity for vascular endothelial markers (CD31, ERG, factor VIII) and absence of MDM2 expression, confirming the diagnosis of angiosarcoma. Pulmonary hemorrhagic necrosis from tumor infiltration or pulmonary tumor thrombotic microangiopathy might have caused his rapid respiratory deterioration. CONCLUSIONS: Left atrial angiosarcoma can present with acute life-threatening complications requiring emergency surgery. Despite successful tumor debulking, the prognosis remains poor because of aggressive tumor biology and potential pulmonary metastases. This case emphasizes that management of primary cardiac angiosarcoma remains challenging despite prompt surgical intervention.

DOI： 10.70352/scrj.cr.25-0759

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Obesity is an independent risk factor for heart failure (HF) onset; however, weight loss is an independent poor prognostic factor in patients with HF. According to the obesity paradox, higher body weight is associated with better prognosis in these patients. This retrospective cohort study investigated the obesity paradox in super-elderly, understudied patients (aged ≥ 85 years) with HF and examined its impact on all-cause mortality. We included patients hospitalized for HF between April 2015 and March 2023. Participants were divided into four age groups: Groups A (< 65 years), B (65-74 years), C (75-84 years, elderly), and D (≥ 85 years, super-elderly). The primary endpoint was the 1-year all-cause mortality rate after discharge. The secondary endpoints included cardiac and non-cardiac death rates and all-cause mortality rates stratified by left ventricular ejection fraction (LVEF). Overall, 3,811 individuals (mean age: 74.3 years, 60.4% men) were included. A trend toward higher all-cause mortality rates associated with underweight (body mass index [BMI] < 18.5 kg/m2) was observed in all age groups. Patients with obesity (BMI ≥ 25.0 kg/m2) had significantly better survival than other patients. Underweight was associated with a higher cardiac death rate compared with the other weight categories (P = 0.014, 0.039, and 0.022 for groups B, C, and D, respectively). In the analysis stratified by LVEF, underweight was significantly associated with a higher cardiac death rate in patients with HF with preserved LVEF compared with the other weight categories (P < 0.001). The obesity paradox in the super-elderly population was confirmed. It is important to consider BMI in HF management and prognosis.

DOI： 10.1007/s00380-025-02597-5

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/ehjci/jead341

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J-GLOBAL

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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