Possibilities of using desmin detection in the myocardium in the diagnostics of sudden and unexpected cardiac death

Overview

Cases of sudden and unexpected deaths from cardiac causes are a frequent subject of post mortem investigation in everyday forensic practice. They occur in all age categories. Morphological findings at autopsy may reveal pathological changes in the myocardium, e.g. acute infarction, all forms of myocarditis, cardiomyopathy of various aetiologies, congenital coronary artery anomalies, lesions of the cardiac conduction system and primary heart tumours, especially in the elderly. At a younger age, the autopsy findings are mostly poor in morphological changes and the cause of death is often determined per exclusionem as a functional diagnosis of cardiac failure. Early ischemic changes or early myocardial infarction is sometimes impossible to detect macroscopically and also microscopically in tissue sections with conventional staining. Desmin is cytoplasmic structural protein found in striated muscle, associated with Z-lines in muscle cell and is sensitive to oxygen deficiency. In myocardial samples taken at autopsy, desmin can be visualized by immunohistochemistry with specific antibody-antigen reaction. The aim of the presented work is to approach the possibilities of using desmin detection in the myocardium using immunohistochemical examination and modern methods of evaluating its results using image analysis in the diagnostics of sudden and unexpected cardiac death.

Keywords:

sudden and unexpected cardiac death – early ischemic changes of the myocardium – desmin – immunohistochemistry – Image analysis