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Necropsy study of association between sudden death and cardiac enzymes
J Burns1, C M Milroy, B Hulewicz
1Sub-department of Forensic Pathology, University of Liverpool.
Insights
Measuring cardiac enzymes at necropsy can identify early myocardial infarction, even before physical signs appear. This aids in diagnosing sudden cardiac deaths due to ischemia.
Area of Science:
- Forensic Pathology
- Biochemistry
- Cardiology
Background:
- Diagnosing early myocardial infarction (MI) can be challenging, especially in post-mortem examinations.
- Histological evidence of MI may not be apparent in early stages.
Purpose of the Study:
- To investigate the utility of cardiac enzyme measurements at necropsy for predicting early myocardial infarction.
- To assess if enzyme levels can identify MI before macroscopic or microscopic changes are visible.
Main Methods:
- Cardiac enzyme activities (creatine phosphokinase, isoenzymes, aspartate aminotransferase, hydroxybutarate dehydrogenase) were measured in pericardial fluid and blood samples from necropsies.
- Cases were categorized based on gross and microscopic findings: definite MI, coronary atheroma without MI, and non-cardiac cases.
- Logistic regression analysis was employed to analyze the enzyme activity data.
Main Results:
- Elevated levels of creatine phosphokinase and its isoenzymes were significantly associated with cardiac disease deaths.
- Cardiac enzyme activities demonstrated high discriminatory power.
- Early MI cases, lacking routine histological evidence, were identifiable through enzyme level analysis.
Conclusions:
- Cardiac enzyme measurements in post-mortem blood and pericardial fluid offer valuable supplementary data.
- These enzyme assays can aid in diagnosing sudden deaths from myocardial ischemia occurring before definitive pathological evidence.
- This method enhances the diagnostic capabilities in forensic and clinical pathology for early MI detection.
Aims:
To determine if cardiac enzymes measured at necropsy could be used to predict early myocardial infarction.
Methods:
Cardiac enzyme activities were measured in body fluids at necropsy. Coroners' necropsies were grouped by gross and microscopic findings into cases of definite myocardial infarction, cases with occlusive coronary artery atheroma but no identifiable myocardial infarction, and non-cardiac cases. Pericardial fluid, peripheral venous blood, and blood from the right atrium were collected. Total creatine phosphokinase, creatine phosphokinase isoenzymes, aspartate aminotransferase and hydroxybutarate dehydrogenase activities were measured and the results analysed by logistic regression.
Results:
The values of creatine phosphokinase and its isoenzymes were raised in those who had died of cardiac disease and were most discriminatory. Cases of early myocardial infarction without evidence of infarction on routine histological examination could be identified from enzyme activities.
Conclusions:
Measurement of cardiac enzymes in blood and pericardial fluid at necropsy can provide valuable additional information in cases of sudden death as a result of myocardial ischaemia which have occurred before macroscopic or microscopic evidence of myocardial infarction.