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Autopsy in the era of advanced cardiovascular imaging
Cristina Basso1, James R Stone2
1Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua 35121, Italy.
Insights
Clinical autopsies remain vital for understanding cardiovascular diseases, especially in unexpected deaths. Autopsies enhance knowledge of disease progression, imaging accuracy, and new cardiac pathologies.
Area of Science:
- Cardiovascular Pathology
- Medical Diagnostics
- Clinical Autopsy
Background:
- Autopsies have historically driven advances in cardiovascular anatomy, physiology, and pathology.
- Key discoveries in atherosclerosis, coronary artery disease, congenital heart diseases, and cardiomyopathies resulted from autopsy investigations.
- Clinicopathological correlations from autopsies are crucial for medical understanding.
Purpose of the Study:
- To review the importance of clinical autopsies in cardiovascular disease deaths, even with advanced imaging.
- To highlight the role of autopsies in sudden unexpected deaths where imaging may be absent.
- To emphasize the continued value of post-mortem examinations in understanding disease and improving diagnostics.
Main Methods:
- Review of historical and current literature on cardiovascular disease and autopsy findings.
- Analysis of the role of autopsy in various cardiovascular conditions, including sudden death and complex cases.
- Discussion of autopsy's contribution to understanding disease natural history and imaging modality performance.
Main Results:
- Autopsies are essential for diagnosis in sudden unexpected deaths, particularly without prior advanced imaging.
- Even with advanced imaging, autopsies provide critical insights into underlying cardiovascular diseases.
- Post-mortem examinations improve understanding of disease progression, rare presentations, and treatment complications.
- Autopsies are vital for assessing the sensitivity and specificity of cardiovascular imaging techniques.
- Autopsies aid in rapidly characterizing cardiac pathology of emerging diseases, as seen with COVID-19.
Conclusions:
- Clinical autopsies remain indispensable for advancing cardiovascular disease knowledge and diagnostics.
- Autopsies are crucial for understanding disease mechanisms, validating imaging, and identifying new cardiac pathologies.
- The review underscores the enduring significance of autopsy in cardiovascular medicine and public health.
Abstract:
Historically, autopsy contributed to our current knowledge of cardiovascular anatomy, physiology, and pathology. Major advances in the understanding of cardiovascular diseases, including atherosclerosis and coronary artery disease, congenital heart diseases, and cardiomyopathies, were possible through autopsy investigations and clinicopathological correlations. In this review, the importance of performing clinical autopsies in people dying from cardiovascular disease, even in the era of advanced cardiovascular imaging is addressed. Autopsies are most helpful in the setting of sudden unexpected deaths, particularly when advanced cardiovascular imaging has not been performed. In this setting, the autopsy is often the only chance to make the correct diagnosis. In previously symptomatic patients who had undergone advanced cardiovascular imaging, autopsies still play many roles. Post-mortem examinations are important for furthering the understanding of key issues related to the underlying diseases. Autopsy can help to increase the knowledge of the sensitivity and specificity of advanced cardiovascular imaging modalities. Autopsies are particularly important to gain insights into both the natural history of cardiovascular diseases as well as less common presentations and therapeutic complications. Finally, autopsies are a key tool to quickly understand the cardiac pathology of new disorders, as emphasized during the recent coronavirus disease 2019 pandemic.
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