Reliability of Post Mortem Pericardial Fluid Troponins for Diagnosis of Myocardial Infarction

Abstract

Introduction: The purpose of this study was to evaluate the diagnostic role of postmortem pericardial fluid cardiac troponins in cases of sudden cardiac death and to determine its significance. Methods: This study included totally 30 cases, of which 23 were cases of sudden cardiac death and 7 were control cases. In the following cases, along with age, gender, as well as circumstance of death, level of cardiac troponin I In pericardial fluid, cytological analysis of the fluid as well as post mortem findings of the coronary arteries were all analyzed. Levels of troponin I were assessed with the help of a rapid card test which worked on the principle of sandwich immunoassay. It detects a minimum amount of 0.5ng/ml of cTnI in samples. Results: In the 30 cases among which the study was conducted, the mean age was 44 years of age, with the majority of the cases lying between the ages of 41–50 (37%). It was also found that the majority of them were males (86.7%) as compared to females (13.3%). The mean time interval between death and sample testing came up to 11 hours, with the majority of the cases being between 16–20 hours time interval (37%). On correlation of rapid card test results and gross post mortem findings, the test showed a sensitivity of 86.7% and specificity of 20%. Conclusion: From statistical analysis it could be inferred that the frequency of MI was more in males than females, and in the age group of 41–50. The rapid card test had an appreciable sensitivity, but the specificity inferred there could be various situations in which there could be elevated troponins in pericardial fluid. This infers that while a case of myocardial infarction has a higher chance of showing elevated levels of cardiac troponin in pericardial fluid, a case of sudden death can not be reliably diagnosed as AMI on the basis of elevated troponins alone. There must be correlation between clinical, histopathological and cardiac marker findings.