On the use of Biochemical Markers in Diagnostics of Sudden Cardiac Death

Czech version

Authors: J. Šidlo ¹; V. Parrák ²; P. Kvasnička ³; M. Majdan ²; H. Šidlová ⁴
Authors‘ workplace: Institute of Forensic Medicine, School of Medicine, Comenius University and Health Care Surveillance Authority, Bratislava, Slovakia ¹; Department of Clinical Biochemistry, Teaching Hospital (workplace Petržalka), Bratislava, Slovakia ²; Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia ³; Institute of Pathology, Slovak Medical University and Cytopathos, s. r. o., Bratislava, Slovakia ⁴
Published in: Soud Lék., 53, 2008, No. 3, p. 31-34

Overview

Introduction:
Medical examiners frequently examine victims of sudden death. Most often sudden deaths have a cardiovascular cause. To determine the diagnosis of sudden cardiac death based only on morphological findings may be often very difficult. Measurement of blood concentrations of cardiac troponin I (cTnI) and atrial natriuretic peptide (pro-ANP) is now in clinical use in adult patients with heart failure caused by myocardial damage.

Aim:
The aim of the study was the estimation wheather cTnI and/or pro-ANP could be markers of sudden cardiac death.

Patients and methods:
The study was carried out on 89 necroptic cases, of which 53 were concluded as cardiac-related sudden death, and 36 cases were used as a control group being other than cardiac death cases. Concentrations of markers were determined in blood taken from the left cardiac ventricle and from the right femoral vein. The dependence between the results of biochemical studies and death causes, results of histopathological examination of myocardium, time interval between the death and taking of samples, and resuscitation data was investigated.

Results:
Concentrations of cTnI as determined in blood samples from the left ventricle were in most cases very high, largely exceeding the cut-off level, and so were concentrations of pro-ANP. The values of both parameters were significantly lower in peripheral blood. No statistically significant dependences were found between the levels of the studied markers and the cause of death, myocardial histopathological findings, time interval between the death and taking of samples, and resuscitation data.

Conclusion:
Based on the results obtained, the study can be concluded that blood is not a suitable medium for determination of biochemical markers of cardial troponin I and atrial natriuretic peptide for post-mortem diagnostics of myocardial damage and for determining the diagnosis of sudden cardiac death in a manner similar to diagnostics of myocardium damage in living patients.

Key words:
sudden cardiac death – morphology - biochemical markers – cardiac troponin I – atrial natriuretic peptide

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Article was published in

Forensic Medicine

2008 Issue 3