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Significance of postmortem biomarkers and multimarker strategy in sudden cardiac death
Erdi Kutlu1, Nazlı Çil2, Esin Avci3
1Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
Insights
Postmortem biochemical markers like hs-cTnT, NT-proBNP, and H-FABP can aid in diagnosing sudden cardiac death (SCD) from ischemic heart disease. A multi-marker approach combining hs-cTnT, NT-proBNP, and pentraxin-3 achieved 94.9% accuracy in classifying SCD cases.
Area of Science:
- Forensic Pathology
- Cardiovascular Pathology
- Biochemistry
Background:
- Ischemic heart disease is the primary cause of sudden cardiac death (SCD).
- Traditional histopathological examination for postmortem diagnosis of ischemia is limited, especially in early postmortem stages.
- Postmortem biochemical markers offer a promising alternative for diagnosing ischemia.
Purpose of the Study:
- To evaluate the utility of specific biochemical markers in postmortem serum for diagnosing SCD.
- To investigate the effectiveness of a multi-marker strategy in forensic pathology for SCD diagnosis.
- To identify the optimal combination of markers for accurate SCD classification.
Main Methods:
- Serum samples from 35 SCD cases and 24 control cases were analyzed.
- Biochemical markers including high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), pentraxin-3, copeptin, ischemic modified albumin (IMA), and pregnancy-associated plasma protein-A (PAPP-A) were measured.
- Statistical analysis was performed to compare marker levels between groups, and multi-marker models were developed and evaluated.
Main Results:
- hs-cTnT, NT-proBNP, and H-FABP levels were significantly elevated in the SCD group compared to controls.
- A multi-marker model combining hs-cTnT (ischemia marker), NT-proBNP (stress marker), and pentraxin-3 (inflammation marker) demonstrated high accuracy.
- This optimal model correctly classified 94.9% of cases, indicating superior diagnostic performance.
Conclusions:
- Biochemical markers, particularly hs-cTnT, NT-proBNP, and H-FABP, are valuable in the postmortem diagnosis of SCD.
- A multi-marker strategy, analogous to clinical practice, enhances diagnostic accuracy in forensic pathology.
- The combination of hs-cTnT, NT-proBNP, and pentraxin-3 represents a highly accurate approach for identifying SCD.
Abstract:
The most common cause in the etiology of sudden cardiac death (SCD) is ischemic heart disease due to atherosclerosis. Postmortem diagnosis can be made by histopathological examinations, but routine histopathological examinations are limited, especially in the early period of postmortem ischemia. For this reason, many methods are being investigated for the postmortem diagnosis of ischemia, and postmortem biochemical studies are promising. In our study, we evaluated the biochemical markers; hs-cTnT, NT-proBNP, H-FABP, pentraxin-3, copeptin, ischemic modified albumin (IMA), and PAPP-A in postmortem serums. In forensic pathology practice, it was investigated whether it would be useful to go to the diagnosis by measuring more than one marker in a single biological fluid in SCD cases. The study included 35 sudden cardiac death cases and 24 control cases and as a result of our study, hs-cTnT, NT-proBNP, and H-FABP values were found to be significantly higher in the SCD group than in the control group. Within the scope of the multi-marker strategy, models were tried to be developed in which the markers were used together, and it was concluded that the model consisting of the myocardial ischemia marker hs-cTnT, the myocardial stress marker NT-proBNP, and the inflammation marker pentraxin 3 was the most accurate combination by correctly classifying the cases at a rate of 94.9%. As a result, it was thought that it would be appropriate to use the multi-marker strategy which is widely used in clinical applications, also in forensic medicine applications.
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