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[Problems in applying a rapid assay kit for cardiac troponin T to medico-legal blood samples]
Kotaro Matoba1, Koichi Terazawa, Satoshi Watanabe
1Forensic Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
Insights
Cardiac troponin T (cTnT) rapid assay kits are unreliable for determining cardiac-related death in forensic medicine. Postmortem blood analysis shows high positive rates regardless of the actual cause of death, making results inconclusive.
Area of Science:
- Forensic pathology
- Clinical toxicology
- Cardiology
Background:
- Diagnosing cardiac-related death solely by external examination is challenging.
- In regions lacking medical examiner systems, external examination is primary for death cause determination.
- Cardiac troponin T (cTnT) rapid assay kits, used clinically for ischemic heart disease, are being explored for forensic applications.
Purpose of the Study:
- To evaluate the utility of cardiac troponin T (cTnT) rapid assay kits in forensic medicine.
- To assess the reliability of cTnT testing for diagnosing cardiac-related deaths in postmortem cases.
Main Methods:
- Collected postmortem blood samples from 110 forensic autopsy cases.
- Analyzed blood samples from cardiac chambers and peripheral circulation using cTnT rapid assay kits.
Main Results:
- Extremely high positive rates for cTnT were observed in cardiac blood samples (95.1%) and peripheral blood samples (71.2%).
- Cardiac-related deaths constituted only 7 out of 110 total cases.
- High positive rates were found irrespective of the confirmed cause of death.
Conclusions:
- Cardiac troponin T (cTnT) concentrations in postmortem blood are significantly affected by non-cardiac factors.
- Factors such as postmortem changes, non-cardiac natural death, and cardiopulmonary resuscitation can influence cTnT levels.
- The study concludes that cTnT rapid assay kits are not reliable for determining the cause of death in forensic medicine.
Abstract:
It is difficult to diagnose cardiac-related death only by external examination. However, in the areas where no medical examiner system is established, the diagnosis is made mostly from the findings by external examination. Clinically, cardiac troponin T (cTnT) rapid assay kits are used for the diagnosis of ischemic heart disease. The kits have started being applied to forensic medicine and used for the diagnosis of cardiac-related death without exact evidence. In this study, we collected postmortem blood samples from 110 forensic autopsy cases and evaluated the utility of the kits in the field of forensic medicine. Blood samples collected from the left and the right parts of the hearts showed extremely high positive rates (95.1% each), and peripheral blood samples also showed very high positive rates (71.2%), although cardiac-related deaths were only 7 cases of all 110 cases. Because cTnT concentration of postmortem blood samples is affected by non-cardiac-related natural death, postmortem changes, or cardiopulmonary resuscitation, the results from using the kits are not reliable in determining the cause of death. We conclude that the kits cannot be applied in forensic medicine.
