Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1. Analysis with special regard to traumatic causes of death

Abstract

In forensic pathology, previous studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction. However, there appears to be insufficient practical data on other causes of death. The present study was a comprehensive analysis of the cardiac, peripheral blood and pericardial levels of cardiac troponin T (cTnT) in serial medicolegal autopsy cases ( n=405) with a survival time <24 h and within 48 h postmortem to assess the validity of investigating myocardial damage with special regard to traumatic causes of death. These included blunt and sharp instrument injury ( n=122 and 21, respectively), asphyxiation ( n=35), drowning ( n=27), fire fatalities ( n=94), hyperthermia ( n=13), hypothermia ( n=6), fatal methamphetamine (MA) abuse ( n=12) and carbon monoxide (CO) poisoning ( n=5) in comparison with myocardial infarction (MI, n=57) and cerebrovascular diseases ( n=13). Cases within 12 h postmortem usually showed lower cardiac and pericardial cTnT levels than did those of longer postmortem time of 12–48 h. In the early postmortem period of <12 h, significantly elevated serum cTnT levels were observed for hyperthermia. Thereafter, fatal MA abuse, CO poisoning and MI cases also showed higher levels. However, cTnT remained at lower levels for hypothermia and drowning. The elevation of cTnT was associated with the pathology of advanced myocardial damage involving swelling and liquefactive necrosis. The above-mentioned differences were the smallest for peripheral blood. These findings suggest that elevations in postmortem serum and pericardial cTnT levels depend on the severity of myocardial damage at the time of death and are related to the pathological findings, although postmortem interference should be taken into consideration.