Utilidad de la determinación de troponina T, CK-MB, NT-proBNP y mioglobina en humor vítreo en autopsias forenses

Abstract

IntroductionThe use of biochemical assays for serum cardiac markers as a complement to the histological study of the heart have been proposed in assessment forensic diagnosis of cardiac death. Investigations in different fluids like vitreous humour (VH) could help in avoid modification due to haemolysis. ObjectivesEvaluation of the levels in VH of 4 well known serum clinical markers for cardiac disease (T-troponin, myoglobin, MB-CK, and NTpro-BNP), in cases of sudden death of cardiac origin and controls. Material and methodsWe analyzed samples from 40 cases of forensic autopsies (25 of cardiac origin, 15 other causes), using electro chemiluminescence immunoassay (ECLIA) method. Results for non-parametric test (Kruskal-Wallis), comparison of groups (Mann-Whitney), and ROC curve were performed by SPSS 15.0 statistics. ResultsT-troponin levels were undetectable in vitreous humor, and myoglobin shows very low and invariable levels, both unable to be used as a diagnostic tool. CK-MB shows no accurate distribution between the 2 groups of cause of death, probably due to post-mortem instability and low specificity. Finally, mean levels of NTpro-BNP were significantly higher in individuals who died from cardiac causes (133.4 ± 48.8 pg/mL vs 87.3 ± 34.7 pg/mL; P=.002), and the ROC curve shows an area under the curve = 0.801. ConclusionsNTpro-BNP levels in vitreous humor determination could play a role as an auxiliary tool in diagnosis of death from cardiac origin in forensic autopsy cases.