Postmortem cardiac troponin-I levels predict intramyocardial damage at autopsy

Abstract

Serum cardiac troponin levels are now widely used in the diagnosis of myocardial infarct (MI) and injury in living patients, but their utility in postmortem diagnosis has not been established. We evaluated postmortem cardiac troponin-I (cTnI) levels in serum from 53 hospital patients undergoing autopsy and correlated the levels with anatomic findings at postmortem examination. Among patients with nonischemic cardiac disease, those with intramyocardial disease (e.g., cardiac transplant rejection, intramyocardial tumor) had significantly higher cTnI levels than those with disease confined to the pericardium (e.g., epicardial tumor implants, pericarditis) (p = 0.004). No correlation was found between recent MI and cTnI level. There was also no correlation between cTnI level and the presence of chronic ischemic features, a history of cardiopulmonary resuscitation, or postmortem interval. We conclude that cTnI is detectable in postmortem serum samples and, although its levels did not correlate specifically with ischemia or infarction in our series, its levels appear to correlate significantly with intramyocardial injury. Use of cardiac troponin in the postmortem diagnosis of cardiac disease may be warranted.

Recognition of Early Myocardial Infarction by Immunohistochemical Staining with Cardiac Troponin‐I and Complement C9*

“…As previously mentioned, MI is hard to detect through macroscopic examination as well as routine histological staining until approximately more than 6 h after the onset of MI (15). Hansen and Rossen (16) conducted trials in 1999 that detected necrotic myocardial tissue by immunohistochemical staining with CT-I.…”

Cardiac biomarkers in blood, and pericardial and cerebrospinal fluids of forensic autopsy cases: A reassessment with special regard to postmortem interval

“…Postmortem biochemistry can provide significant information regarding the cause of death, demonstrating systemic pathophysiological changes involved in the dying process, when agonal and postmortem interference is carefully considered [7,[20][21][22]. However, because of the breakdown of vital activities, involving circulation and tissue cell membrane integrity, the diffusion and redistribution of intra-and extracellular components start at the time of death, depending on their concentration gradients [7].…”

Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination

“…For example, troponins (I and T) are known to be the preferred markers for the laboratory diagnosis of myocardial infarction in the clinical setting [25, 26]. Conversely, in the post mortem context, not only they are not specific for myocardial injury, as they increase also in other conditions [27, 28], but also their levels are influenced by the post mortem interval [28–30]. Some authors even pointed out that post mortem blood is an unsuitable sample to measure cardiac troponins [31].…”