Diagnostic value of high-sensitivity troponin T in postmortem diagnosis of sudden cardiac death

• Published in: Journal of forensic and legal medicine 2021-02, Vol.78, p.102127-102127, Article 102127
• Main Authors: Zribi, M., Ennouri, H., Turki, M., Ben Amar, W., Grati, M.A., Hammami, Z., Ayadi, F., Maatoug, S.
• Format: Article
• Language: English
• Subjects: Adult; Autopsy; Blood Chemical Analysis; Death, Sudden, Cardiac; Female; High-sensitivity troponin T; Humans; Male; Middle Aged; Pericardial Fluid - chemistry; Postmortem interval; Prospective Studies; ROC Curve; Sensitivity and Specificity; Sudden cardiac death; Troponin T - analysis; Tunisia
• ISSN: 1752-928X; 1878-7487
• DOI: 10.1016/j.jflm.2021.102127

Ischemic heart disease is the most common cause of sudden cardiac death. By autopsy, there may be no histologic evidence of acute myocardial damage few hours after death. The use of cardiac troponins in the postmortem diagnosis of sudden cardiac death is well known in the forensic setting. However, high-sensitivity cardiac troponin T (Hs-TnT) assay in cadaver fluids was tested in few studies. The aim of this study is to assess the diagnostic value of postmortem dosage of Hs-TnT in the diagnosis of sudden cardiac death. Our study is prospective, dealing with cadavers autopsied at the Department of Forensic Medicine of the University Hospital Habib Bourguiba of Sfax-Tunisia from December 2016 to April 2018. Were excluded from the study resuscitated cases, severely traumatized victims and cadavers that were examined more than 36 h after death. Levels of Hs-TnT were measured in pericardial fluid, cardiac blood and peripheral blood. A total of 80 cases were identified with an average age of 44.5 ± 19 years. Hs-TnT levels in pericardial fluid and heart blood were correlated significantly between cardiac and non-cardiac groups with a p-value respectively at 0.14 and 0.04. Receiver-operator characteristic curves analysis showed that the pericardial fluid had the best sensibility (75%) and specificity (64%) with a cut-off level at 17.72 ng/ml and an area under the curve at 0.747. We found also a significant correlation between postmortem interval and Hs-TnT levels in pericardial fluid, cardiac and peripheral blood. Our data indicate that determination of cardiac troponin T by a highly sensitive assay in pericardial fluid may be a powerful aid in the postmortem diagnosis of sudden cardiac death. •Significant elevation of pericardial Hs-TnT levels in sudden cardiac deaths.•No significant correlation between Hs-TnT serum levels and cardiac-related death.•Significant correlation between Hs-TnT concentrations and the postmortem interval.