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Evaluation of eosin-fluorescence in the diagnosis of sudden cardiac death
Insights
The eosin-fluorescence method shows potential for diagnosing sudden cardiac death (SCD) but is too sensitive and unreliable for medicolegal use due to high false positive rates.
Area of Science:
- Forensic Pathology
- Biochemistry
Background:
- Sudden cardiac death (SCD) diagnosis relies on accurate postmortem analysis.
- Enzyme histochemical methods like beta-hydroxybutyrate-dehydrogenase (beta-HBDH) are established diagnostic tools.
- Novel fluorescence methods require validation against established techniques.
Purpose of the Study:
- To evaluate the diagnostic significance of the eosin-fluorescence method in sudden cardiac death.
- To compare eosin-fluorescence with beta-hydroxybutyrate-dehydrogenase (beta-HBDH) and hyperchromasia.
- To assess the impact of postmortem autolysis on fluorescence findings.
Main Methods:
- Analyzed 568 heart samples from sudden cardiac death (SCD) and control cases.
- Compared eosin-fluorescence with beta-HBDH enzyme histochemistry and hyperchromasia.
- Investigated autolysis effects at +4°C and +22°C.
Main Results:
- Yellow-fluorescence and hyperchromasia increased significantly from controls to beta-HBDH-positive SCD cases (P < 0.001).
- Fluorescence changes did not correlate with beta-HBDH activity or hyperchromasia patterns.
- Postmortem autolysis did not significantly alter fluorescence, but 78% false positives occurred in controls.
Conclusions:
- Eosin-fluorescence shows a significant difference between SCD and control groups.
- The method's high false positive rate makes it unreliable for medicolegal diagnosis of SCD.
- Further refinement is needed to improve specificity and reliability.
Abstract:
The diagnostic significance of the eosin-fluorescence method was evaluated and compared with the enzymehistochemical beta-hydroxybutyrate-dehydrogenase method (beta-HBDH) and the degree of hyperchromasia in 568 samples from 24 bets-HBDH-negative and beta-HBDH-positive sudden cardiac deaths (SCD) and 23 non-cardiac deaths as controls. The effect of autolysis was investigated separately on isolated human hearts at +4 degrees C and +22 degrees C. All samples were examined without any knowledge of clinical or autopsy data. Normal olive-green fluorescence was observed in only five individuals of the control group and two in the beta-HBDH-negative one. The frequency of the yellow-fluorescence and hyperchromasia increased from the control subjects towards the beta-HBDH-positive-ones. The difference in frequency distribution of fluorescence between the groups was statistically highly significant (P less than 0.001). The change in fluorescence did not correlate with the loss of beta-HBDH-reaction or the distribution pattern of hyperchromasia. Postmortem autolysis did not change the fluorescence significantly but the 78% wrong positive subjects in the control group render this method too sensitive and unreliable for medicolegal purposes.