Autopsy examination in sudden cardiac death: a current perspective on behalf of the Association for European Cardiovascular Pathology

Abstract

In sudden cardiac death, an autopsy is an essential step in establishing a diagnosis of inherited cardiac disease and identifying families that require cardiac screening. To evaluate aspects of post-mortem practice in Europe, a questionnaire was designed and circulated to both clinical and forensic pathologists. There was a 48% response rate and information was obtained from 17 countries. The results showed a wide variety in the management of sudden cardiac death, with a general tendency towards a lack of thorough investigation. In up to 40% of cases, autopsies were not performed in subjects less than 50 years who may have died from cardiac disease. Reasons for this were lack of finance and lack of interest from police, legal authorities, and doctors. Only 50% of pathologists seem to follow a standard protocol for autopsy examination, apparently due to lack of expertise and/or training. When autopsies were performed, histology and toxicology were almost always taken, genetic studies were generally available and retention of the heart for specialist study was usually permitted. Our results suggest that although the standard of practice is appropriate in many centres, many more cases should have autopsies, especially in sudden deaths in subjects less than 50 years.

A COVID-19-association-dependent categorization of death causes in 100 autopsy cases

“…Coronary artery disease of varying extent was seen together with interstitial fibrosis. This combination probably constitutes a high-risk factor for COVID-19 death, as has been suggested [2,36,37]. Chronic myocardial damage and vessel remodeling indicated histories of cardiovascular ischemic disease originating years before fatal SARS-CoV-2 infection.…”

“…The majority of patients (n=57) were included in the strong association with COVID-19 category (1), with cause of death directly due to SARS-CoV-2 infection and its sequelae. Another group of patients (n=27) classified to the contributive association with COVID-19 category (2) where death was caused by a pre-existing condition independent of COVID-19, yet the infection was not altogether irrelevant, therefore, contributing to death. A third cohort of decedents (n=16) belonged to the weak association with COVID-19 category (3), in which viral infection had little or no effect on death.…”

“…Since the onset of the present pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [ 1 ], several studies have presented the results of autopsies performed in coronavirus disease 2019 (COVID-19) [ 2 – 22 ]. Systematic meta-analyses also have appeared [ 18 , 23 , 24 ].…”

A COVID–19 patológiája.

“…A tüdő mellett az ún. cardiovascularis rendszer, tehát a szív-és az érrendszer a legsúlyosabban érintett COVID-19-ben, amelyre több szerző is felhívja a figyelmet (Banner et al 2021;Bermejo-Martin et al 2020). Az elváltozások elemzésénél feltétlenül figyelembe kell venni, hogy az elhunytak többsége idős beteg, akik gyakran már vál-tozó súlyosságú szív-és érbetegségben, elsősorban az atherosclerosis különböző fokozatában, krónikus tüdőbetegség miatti jobb szívfél elégtelenségben stb.…”

A Comprehensive Review of Pathological Examination in Forensic Medicine: Past, Present, and Future

“…Lack of appropriate training of pathologists and forensic experts always widens the range of discrepancy of diagnosis. Geller et al along with many authors strongly recommended pathologists to improve the quality of PE[7][8][9]54,55]. Royal College Pathologist, European Society for Forensic Science, and American Academy of Forensic Sciences laid down various guidelines/protocols for death in different death scenarios with continuous training programs in the wake of updating and uniformity.…”