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Redefining the Post-Mortem Investigation of Sudden Cardiac Death: Systematic Cardiac MR with Macroscopic and
Lorenzo Pagnan1, Alessandro Sarno1, Matteo Cesarotto1
1Radiology Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34127 Trieste, Italy.
Insights
Post-mortem cardiac MRI (PM-CMR) effectively identifies causes of sudden cardiac death (SCD) in explanted hearts, showing good agreement with autopsy results. This technique aids in diagnosing SCD and supporting family screening.
Area of Science:
- Cardiovascular Pathology
- Medical Imaging
- Forensic Medicine
Background:
- Sudden cardiac death (SCD) is a major cause of mortality, often linked to coronary artery disease (CAD) in older adults and various myocardial diseases in younger individuals.
- Identifying the morphological causes of SCD is crucial for understanding disease mechanisms and implementing preventive strategies.
Purpose of the Study:
- To evaluate the diagnostic performance of post-mortem cardiac magnetic resonance imaging (PM-CMR) in formalin-fixed explanted hearts.
- To assess the concordance between PM-CMR findings and autopsy results, particularly in sudden coronary death cases.
Main Methods:
- Retrospective review of 110 post-mortem cardiac MRI examinations from a regional sudden cardiac death registry.
- Analysis of 101 cases included in the final study, comparing PM-CMR findings with autopsy data.
Main Results:
- PM-CMR detected pathological findings in 59% of cases (60 out of 101 hearts).
- Acute ischemic lesions were identified in 39 cases, with other conditions like hypertrophic cardiomyopathy in 21 cases.
- A strong agreement (Cohen's kappa = 0.8) was observed between PM-CMR and autopsy findings.
Conclusions:
- PM-CMR is effective in identifying morphological and signal alterations related to SCD, complementing conventional autopsy.
- Despite limitations with hyperacute lesions, PM-CMR shows promise for SCD diagnosis and family screening programs.
Abstract:
Objectives: Sudden cardiac death (SCD) is a leading cause of mortality, accounting for approximately 50% of all cardiovascular deaths and 20% of all-natural deaths in Western countries. In individuals over 50 years of age, coronary artery disease (CAD) is responsible for more than 80% of cases, whereas in younger subjects SCD is more frequently associated with non-ischemic myocardial diseases, including hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy (ACM), dilated cardiomyopathy (DCM), and myocarditis. Additional causes in young adults include coronary artery anomalies and primary arrhythmic disorders related to channelopathies. This study evaluated the diagnostic performance of post-mortem cardiac magnetic resonance imaging (PM-CMR) in identifying morphological substrates underlying SCD in formalin-fixed explanted hearts, with particular attention to the concordance between PM-CMR findings and autopsy results in cases of sudden coronary death. Material and Methods: We retrospectively reviewed 110 PM-CMR examinations from the Regional Register of Sudden Cardiac Death of Friuli-Venezia Giulia, of which 101 were included in the final analysis. Results: PM-CMR detected pathological findings in 60 hearts (59%), including acute ischemic lesions in 39 cases and other conditions, such as hypertrophic cardiomyopathy, chronic fibrotic ischemic changes, and adipose metaplasia in 21 cases. A good agreement between PM-CMR and autopsy findings was observed (Cohen's kappa = 0.8). Conclusions: Overall, PM-CMR proved effective in identifying relevant morphological and signal alterations, supporting conventional autopsy. Despite some limitations, particularly in hyperacute ischemic lesions, PM-CMR appears to play a promising role in the diagnostic work-up of SCD and in supporting family screening programs for primary prevention.
