Post-Mortem Cardiac Magnetic Resonance in Explanted Heart of Patients with Sudden Death

Abstract

Background: We sought to evaluate the diagnostic accuracy of post-mortem cardiac magnetic resonance (PMCMR) of explanted hearts to detect the cardiac causes of sudden death. Methods: PMCMR was performed in formalin-fixed explanted hearts of 115 cases of sudden death. Histological sampling of myocardium was performed using two different approaches: (1) guideline-based sampling; (2) guideline-based plus PMCMR-driven sampling. Results: Forensic diagnosis of cardiac cause of death was ascertained in 72 (63%) patients. When the guideline-driven histological sampling was used, the PMCMR interpretation matched with final forensic diagnosis in 93 out of 115 cases (81%) with sensitivity of 88% (79–95%), specificity of 65% (47–80%), PPV of 84% (78–90%), NPV of 73% (58–84%), accuracy of 81% (72–88%), and AUC of 0.77 (0.68–0.84). When a PMCMR-driven approach was added to the guideline-based one, the matching increased to 102 (89%) cases with a PMCMR sensitivity of 89% (80–94%), a specificity of 86% (67–96%), PPV of 95% (89–98%), NPV of 73% (59–83%), accuracy of 89% (81–93%), and AUC of 0.88 (0.80–0.93). Conclusions: PMCMR has high accuracy to identify the cardiac cause of sudden death and may be considered a valid auxilium for forensic diagnosis. PMCMR could improve histological diagnosis in conditions with focal myocardial involvement or demonstrating signs of myocardial ischemia.

Autoptic Findings in Cases of Sudden Death Due to Kawasaki Disease

“…Early sudden cardiac death may end a clinically silent course of disease or deteriorate a symptomatic clinical spectrum, such as AMI, arrhythmia, or heart failure [98]. Although sudden death mainly affects children and adolescents, it can also occur 10 to 20 years after diagnosis, making KD unsafe at any age [99].…”

Pregnancy-Associated Spontaneous Coronary Acute Dissection as a Cause of Sudden Cardiac Death—Autopsy Findings and Literature Review: Is COVID-19 Related?

“…With the addition of a PMCMR-driven strategy, the matching went up to 102 cases (89%) (sensitivity of 89%; AUC of 0.88). The authors found that PMCMR exhibited a high degree of accuracy in identifying the cardiac etiology of sudden death and might be used as a legitimate adjunct for forensic diagnosis [ 57 ]. In addition, in another study by Baronti et al, performed on five individuals with SCD who had previously received mRNA vaccinations, the PM-CMR revealed ischemic lesions and coronary artery stenosis in all cases [ 58 ].…”

Postmortem magnetic resonance imaging findings of tricuspid atresia with ventricular and atrial septal defects and subvalvular pulmonic stenosis in a Japanese native Noma horse

“…However, in veterinary medicine, cardiac MRI can be challenging due to anesthesia-induced immobilization and variations in animal body size. Postmortem imaging has garnered attention in human forensic medicine for aiding the diagnosis of sudden death by visualizing cardiovascular abnormalities [ 1 , 3 , 13 ]. This report describes a postmortem MRI performed on the heart of a Noma horse foal that died suddenly.…”

“…In this case, the morphological structure of the cardiac malformation could be understood in 3D by postmortem MRI. Postmortem imaging, particularly MRI, has emerged as a useful adjunct tool to autopsies in cardiac evaluation [ 1 , 3 , 13 , 17 , 19 ]. This technique has the potential to contribute significantly to veterinary medicine research and knowledge advancement.…”

“…Postmortem MRI can provide 3D information of the heart, even after formalin immersion (as in this case), allowing data acquisition when abnormalities are identified at necropsy. Studies in which the hearts of patients who died suddenly were fixed in formalin and subjected to MRI have also reported the utility of postmortem MRI for forensic diagnosis in humans [ 1 , 3 ]. The ability to perform MRI after formalin fixation has the potential to overcome logistical challenges in body transportation, including time constraints due to postmortem changes and geographical limitations related to the installation of facilities.…”