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Post-mortem cardiac-specific troponin-I (cTnI) to determine the cause of non-traumatic hemopericardium
Hans H de Boer1,2, Ethan D Sutton3, Maria Pricone4
1Dept. of Pathology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia. hans.de.boer@vifm.org.
Insights
Post-mortem cardiac-specific troponin I (cTnI) levels can help determine hemopericardium causes when autopsy isn't feasible. Significantly higher cTnI levels in ruptured myocardial infarction cases aid diagnosis, but overlap limits intermediate value.
Area of Science:
- Forensic Pathology
- Cardiovascular Pathology
- Biomarker Analysis
Background:
- Hemopericardium is a common autopsy finding, often caused by myocardial infarction or aortic dissection.
- Post-mortem imaging can be inconclusive in determining the cause of hemopericardium.
- Cardiac-specific troponin I (cTnI) is a potential biomarker for diagnosing cardiac events.
Purpose of the Study:
- To evaluate the utility of post-mortem cardiac-specific troponin I (cTnI) levels in differentiating causes of hemopericardium.
- To compare cTnI levels in cases of ruptured myocardial infarction (RMI) versus aortic dissection (AoD) and controls.
Main Methods:
- Post-mortem cTnI levels were measured in 46 RMI cases, 38 AoD cases, and 44 control cases.
- Statistical analysis and Receiver Operating Characteristic (ROC) curve analysis were performed.
- Likelihood ratios were calculated to assess diagnostic value.
Main Results:
- Median cTnI levels were significantly higher in RMI (5,821 ng/L) compared to AoD (273 ng/L) and controls (95 ng/L).
- A cTnI threshold of 1,483 ng/L showed 87% sensitivity and 90% specificity for distinguishing RMI from AoD.
- Very high (>9688 ng/L) and very low (<250 ng/L) cTnI levels were indicative of RMI or exclusion of RMI, respectively.
Conclusions:
- Post-mortem cTnI testing is a valuable adjunct for diagnosing ruptured myocardial infarction as a cause of hemopericardium when autopsy is not feasible.
- While high and low cTnI levels are informative, intermediate values have limited diagnostic utility due to cohort overlap.
- Autopsy remains the gold standard for definitive cause determination in hemopericardium cases.
Abstract:
Hemopericardium is regularly seen at autopsy and post-mortem imaging. Once traumatic cases and resuscitation artefact are excluded, hemopericardium is almost always due to either ruptured myocardial infarction or aortic dissection. In this study, we explored whether post-mortem cardiac-specific troponin I (cTnI) can be helpful when autopsy is not feasible and post-mortem imaging findings are inconclusive. Post-mortem cTnI levels were compared between 46 cases with hemopericardium due to ruptured myocardial infarction (RMI), 38 cases of hemopericardium due to aortic dissection (AoD), and 44 cases of natural deaths without hemopericardium (controls). The results showed significantly higher cTnI levels in the RMI group (median 5,821 ng/L) compared to AoD (median 273 ng/L) and controls (median 95 ng/L). Receiver operating characteristic (ROC) analysis indicated that a cTnI threshold of 1,483 ng/L provided the best balance of sensitivity (87%) and specificity (90%) for distinguishing RMI from AoD. Levels of cTnI above 9688 ng/L were exclusively seen in RMI, whilst levels < 250 ng/L excluded this diagnosis. Calculated likelihood ratios demonstrated that higher levels of cTnI favour RMI over AoD, but substantial overlap between the cohorts limited the diagnostic value of intermediate cTnI values. Autopsy remains the gold standard for determining the cause of hemopericardium and cTnI testing is best reserved for cases in which an autopsy is not feasible.
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