Ischaemic heart disease. Pato-anatomic findings revealed by comprehensive autopsy technique

Area of Science:

• Cardiovascular Pathology
• Ischemic Heart Disease Research
• Autopsy and Forensic Pathology

Background:

• Ischemic heart disease remains a leading cause of mortality worldwide.
• Understanding the precise pathological correlates of different myocardial infarction types is crucial for clinical management.
• Autopsy studies provide definitive insights into cardiac pathology often unobtainable through in-vivo diagnostics.

Purpose of the Study:

• To investigate the pato-anatomic differences between transmural and sub-endocardial left ventricular acute myocardial infarctions (LV-AMI).
• To correlate specific coronary artery pathologies (thrombosis, stenosis) with LV-AMI types.
• To examine myocardial rupture, coronary vein thrombosis, and conducting system injuries in relation to LV-AMI.

Main Methods:

• Comprehensive autopsy examination of 63 patients deceased from ischemic heart disease.
• Detailed analysis of epicardial coronary vessels, myocardium, and supraventricular conducting system.
• Statistical comparison of findings between transmural and sub-endocardial LV-AMI groups.

Main Results:

• Transmural LV-AMI (two-thirds of cases) more frequently associated with coronary thrombosis (p<0.05).
• Sub-endocardial LV-AMI more often linked to severe stenosis (≥75%) in at least two major arteries (p<0.05).
• Myocardial rupture occurred exclusively in thrombotic transmural LV-AMI without prior infarction; infarction fibrosis higher and survival shorter in sub-endocardial LV-AMI.

Conclusions:

• Distinct pato-anatomic features characterize transmural versus sub-endocardial LV-AMI.
• Coronary artery thrombosis and severe stenosis play differential roles in LV-AMI pathogenesis.
• Autopsy findings confirm clinical diagnoses of AMI with high accuracy (95% definite, 67% probable).