The use of cardiac troponin T (cTnT) in the postmortem diagnosis of acute myocardial infarction and sudden cardiac death: A systematic review

• Published in: Forensic science international 2018-11, Vol.292, p.27-38
• Main Authors: Barberi, Caterina, van den Hondel, Karen E.
• Format: Article
• Language: English
• Subjects: Atherosclerosis; Biochemical markers; Biomarkers - blood; Calcium-binding protein; Cardiac troponin t; Cardiology; Cardiopulmonary Resuscitation; Death, Sudden, Cardiac; Diagnosis; Forensic Medicine; Forensic pathology; Forensic science; Forensic sciences; Gangrene; Heart; Heart attacks; Humans; Immunoassay; Laboratories; Medical diagnosis; Myocardial infarction; Myocardial Infarction - diagnosis; Pericardial Fluid - chemistry; Peripheral blood; Point-of-Care Systems; Postmortem Changes; Postmortem interval; Reproducibility of Results; Sudden cardiac death; Systematic review; Time dependence; Troponin; Troponin T; Troponin T - analysis
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/j.forsciint.2018.09.002

•cTnT is not a specific marker for the postmortem diagnosis of sudden cardiac death.•Up to a postmortem interval smaller than 48h, cTnT seems to be quite stable.•Pericardial fluid samples appeared to be less affected by haemolysis of blood.•CPR seems to have no influence on cTnT values.•No consensus for the cTnT cut-off in forensic practise has been reached. Being sudden cardiac death (SCD) and acute myocardial infarction (AMI) frequent occurrences in forensic medicine, extensive research has been published about the use of cardiac troponin T (cTnT) as a potential specific postmortem biochemical marker. However, cTnT has produced uncertain results, leading to the lack of a standardized application in routine postmortem examinations. The present systematic review focuses on the determination of whether cTnT may be considered as a suitable marker for the postmortem diagnosis of AMI and SCD, analysing the literature according to the following criteria: only human experiments, published from 1st January 2001 to 12th April 2018, available in English, on the following databases: (1). Medline/PubMed/MeSH search words: ((“heart”[MeSH Terms] OR “cardiac”[All Fields]) AND (“troponin”[MeSH Terms] OR “troponins”[All Fields]) AND forensic[All Fields] AND “postmortem”[All Fields]); (2). Embase, Lilacs and Cochrane Library. 16 full-text articles were included. cTnT has been demonstrated to be elevated in a variety of pathological conditions, not strictly related to cardiac causes, but rather to the severity and extent of myocardial damage from various causes. cTnT levels have been consistently found higher in pericardial fluid than in the peripheral blood. Reviewed studies showed that the most suitable biological sample for cTnT evaluation seems to be pericardial fluid, since it may be less affected by haemolysis of blood. cTnT seems to be quite stable up to a PMI (postmortem interval) smaller than 48h; after this time, a mild time-dependent increase has been demonstrated. CPR seems to have no influence on cTnT values. The postmortem cut-offs differ from clinical ones, and at present no consensus has been reached concerning the postmortem ranges. Further research needs to be carried out in order to establish a common accepted cut-off value for forensic use.