Lessons learnt from the autopsies of 445 cases of sudden cardiac death in adults

Michalodimitrakis, Manolis; Mavroforou, Anna; Giannoukas, Athanasios D.

doi:10.1097/00019501-200509000-00008

Cited by 19 publications

(14 citation statements)

References 30 publications

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“…One large-scale multicentre study demonstrated that acute myocardial infarction is 1.28 times more likely to occur between 06:00 and 12:00 than during the other three 6 h intervals of the day (3). Pathological studies have revealed that acute myocardial infarction is the main cause of death in patients with atherosclerotic disease (4,5). The mechanisms of the phenomena are not yet fully understood, but the circadian clock and clock genes may be involved in the process.…”

mentioning

confidence: 99%

Rhythm changes of clock genes, apoptosis-related genes and atherosclerosis-related genes in apolipoprotein E knockout mice

Lü

Hua

et al. 2009

Canadian Journal of Cardiology

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mentioning

confidence: 99%

Rhythm changes of clock genes, apoptosis-related genes and atherosclerosis-related genes in apolipoprotein E knockout mice

Lü

Hua

et al. 2009

Canadian Journal of Cardiology

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“…All of these evidences definitively underline the superiority of functional risk stratification compared with an approach based solely on angiographic coronary anatomy. Past and present observations can be partly explained by the limitations of coronary angiography, which has limited sensitivity compared with necropsy studies 12 and intravascular ultrasound investigations. 13 Furthermore, the identification of significant lesions may be confounded by coronary remodeling and by the extraluminal location of some plaques.…”

Section: Functional Risk Assessment Vs Invasive Coronary Angiographymentioning

confidence: 77%

Physiologic risk assessment in stable ischemic heart disease: still superior to the anatomic angiographic approach

Gimelli

Marzullo

Rovai

2009

Journal of Nuclear Cardiology

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In patients with ischemic heart disease (IHD), a functional risk assessment based on non-invasive tests may conflict with a health care policy oriented toward cost containment and direct reperfusion delivery. In this respect, a survey of the European Society of Cardiology has shown that noninvasive tests are underutilized, with wide variability between different countries, 1 so that several patients without significant IHD directly undergo invasive coronary angiography. On the other hand, coronary lesions detected by coronary angiography often are revascularized even without the evidence that myocardial blood supply or mechanical function is altered. 2 This ''anatomically oriented'' invasive approach may negatively impact patient management, with consequent suboptimal medical treatment, inappropriate revascularizations, additional risks, and increased health costs.To investigate the prognostic power of gated SPECT in current practice, we recently studied a cohort of 676 consecutive patients admitted for known or suspected IHD. 3 Each patient underwent a complete diagnostic work-up that included clinical evaluation, laboratory tests, 12-lead electrocardiogram, two-dimensional echocardiography, stress/rest gated SPECT, and coronary angiography. During follow-up (median, 37 months), 24 patients died from cardiac causes and 19 had a nonfatal myocardial infarction (MI). Several variables were independent predictors of event-free survival (cardiac death and non-fatal MI) in the different phases of diagnostic work-up. When the above predictors were tested together, summed rest score (SRS), summed difference score (SDS), serum creatinine, and LDL/HDL cholesterol were the only final independent predictors of event-free survival (Table 1). The results of this study lead us to make some considerations on risk stratification in stable IHD. FUNCTIONAL RISK ASSESSMENT VS INVASIVE CORONARY ANGIOGRAPHYThe prognostic power of angiographic coronary anatomy has been definitively established. In the CASS registry, 4 the 12-year survival rate of medically treated patients with no significant coronary lesions was 91%, compared with 74%, 59%, and 50% for patients with one-, two-, and three-vessel disease. Survival rate is known to further decrease in the presence of left main coronary artery disease and severe proximal left anterior descending stenosis. 5 To predict patient survival, we used an angiographic semi-quantitative score, which takes into account the number of stenotic coronary arteries, the location of coronary stenoses (proximal, middle, or distal), and the degree of luminal diameter reduction (using a 50% and 70% coronary stenosis threshold). As expected, this score was an independent predictor of event-free survival. However, the prognostic impact of this score disappeared once gated SPECT variables were included into the model. 3 The notion that the prognostic impact of functional risk assessment is superior to angiography is not novel. In patients with defined coronary artery disease, exercise variables primarily relat...

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“…4.11). Correlation of these findings with angiographic data and clinical acute coronary artery syndromes [4] can be particularly instructive. Representative sections of pertinent gross findings should be submitted for histological study.…”

Section: Take the Coronary Arteries Off The Heartmentioning

confidence: 98%

“…4.3) will allow the prosector to begin mobilizing the plane of dissection, proceeding from known (where the plain is exposed) to unknown (where the plane is yet to be exposed) in a deliberate manner. 4 Retraction of pericardium with a clamp exposes a plane of adhesion between the pericardium and heart which can then be developed safely by sharp dissection Developing the plane of dissection between the heart and adherent parietal pericardium should be done with a fresh scalpel, holding the back of the scalpel on the heart (or any structure that the prosector does not want to injure) and the sharp Fig. 4.5 Keeping the back of the knife to the heart and the sharp edge in the plane of dissection exposes a vein graft (arrowhead) without injury, even if the presence of the graft was unknown prior to its exposure edge of the knife directed into the plane of dissection (Fig.…”

Section: The Parietal Pericardium May Be "Socked In"mentioning

confidence: 99%

The Cardiac Dissection

Houser

2009

The Operated Heart at Autopsy

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An approach is offered here to assist the pathologist with the actual dissection of the operated heart at autopsy. The challenge to the pathologist is to define any underlying cardiac pathology, recognize changes in morphology brought about by prior surgical intervention, and correlate the gross cardiac findings with the hemodynamic status of the deceased prior to death. Even without detailed clinical records, one can still perform the dissection in a consistent and careful manner that allows an accurate assessment of the heart regardless of postoperative adhesions and complex surgical reconstructions. Developing the plane of dissection between the heart and adherent parietal pericardium should be done with a scalpel, using a methodical technique. As one examines the external surface of the heart, one may observe clues that the surgeon had used cardiopulmonary bypass to rest the heart during surgery and that specific surgical procedures had been performed. By removal of the coronary arteries with any bypass grafts off the heart and subsequent careful examination of the chambers and great vessels of the heart, the pathologist can then begin to understand the "real story." Keywords Dissection · Pericardium · Heart surgery · Coronary arteries · Surgical footprints · Cardiopulmonary bypass · Sharp dissection In this chapter, an approach is offered to assist the pathologist with the actual dissection of the operated heart at autopsy. This dissection, depending on what operation was done and how long prior to autopsy the operation was performed, may range in complexity from a simple procedure to quite a daunting task. The challenge to the pathologist is to define any underlying cardiac pathology, recognize changes in morphology brought about by prior surgical intervention, and correlate the gross cardiac findings with the hemodynamic status of the deceased prior to death. In short, to what extent did failure of cardiac function contribute to the person's death, and how did the previous heart surgery affect the outcome of the case?Having a detailed knowledge of the deceased's past surgical history, as provided by operative notes, hospital discharge summaries, and available informed clinicians is an obvious advantage to the pathologist at autopsy. However, even without this 31 S.L. Houser, The Operated Heart at Autopsy,

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Lessons learnt from the autopsies of 445 cases of sudden cardiac death in adults

Cited by 19 publications

References 30 publications

Rhythm changes of clock genes, apoptosis-related genes and atherosclerosis-related genes in apolipoprotein E knockout mice

Rhythm changes of clock genes, apoptosis-related genes and atherosclerosis-related genes in apolipoprotein E knockout mice

Physiologic risk assessment in stable ischemic heart disease: still superior to the anatomic angiographic approach

The Cardiac Dissection

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