The histopathological spectrum of myocardial inflammation in relation to circumstance of death: a retrospective cohort study in clinical and forensic autopsies

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial inflammation (n=79). Intervention: Diffuse myocardial inflammation vs. Focal or non-diffuse myocardial inflammation. Primary outcome: Presence of diffuse acute myocarditis across cause of death groups (p=0.021).

Q: What does this research mean for the field?

Only a diffuse increase of inflammatory cells can reliably discriminate between an incidental presence of myocardial inflammation and a potentially significant one as the cause of death, whereas generally used histological parameters are often insufficient. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Romy du Long; Judith Fronczek; Hans W.M. Niessen; Allard C. van der Wal; Hans H. de Boer

doi:10.1080/20961790.2021.1989793

November 25, 2021Forensic Sciences ResearchOpen Access

The histopathological spectrum of myocardial inflammation in relation to circumstance of death: a retrospective cohort study in clinical and forensic autopsies

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Key result

Only diffuse inflammatory cell increases reliably discriminate fatal from incidental myocardial inflammation.

P=0.021
n=79

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Why the study?

Can specific histological parameters differentiate between incidental myocardial inflammation and potentially significant myocarditis as a cause of death?

Study Design

Type

Cohort (n=79)

Multicenter

Yes

Structured PICO

Can specific histological parameters differentiate between incidental myocardial inflammation and potentially significant myocarditis as a cause of death?

P

Population

79 adult autopsy cases with myocardial inflammation (41 forensic, 38 clinical; 56 males, 23 females), divided into 3 groups based on cause of death: Group 1 (obvious unnatural cause, n=27), Group 2 (myocarditis as one of possible causes, n=29), and Group 3 (myocarditis as only significant finding, n=23).

O

Outcome

Histological parameters of myocardial inflammation (distribution, severity, predominant cell type, myocyte injury, fibrosis, edema, hemorrhage) that can discriminate between incidental and potentially significant myocarditissurrogate

Main Result

p-value: p=0.021

In autopsy cases, only a diffuse increase of inflammatory cells reliably discriminates between incidental myocardial inflammation and potentially fatal myocarditis, whereas other histological parameters like myocyte injury do not.

Limitations

Retrospective study design
Lack of genetic testing or family histories to evaluate underlying genetic predispositions to ventricular arrhythmias
Toxicological causes of death were not ruled out for the clinical autopsies
Co-morbidities in Group 2 may have affected the presence or severity of myocarditis
Potential overestimation of myocardial inflammation as the cause of death in some cases
Retrospective design
Lack of genetic testing or family histories to evaluate underlying genetic predisposition to ventricular arrhythmias
Toxicological cause of death not ruled out for clinical autopsies
Co-morbidities in Group 2 may have affected the presence and/or severity of myocarditis

Implication

Supports cautious attribution of death to myocarditis at autopsy; leaves open standardized criteria validation.

Abstract

= 23) consisted of all individuals in which myocarditis was reported to be the only significant finding at autopsy, and no other cause of death was found. Systematic application of our histological parameters showed that only a diffuse increase of inflammatory cells could discriminate between an incidental presence of inflammation (Group 1) or a potentially significant one (Groups 2 and 3). No other histological parameter showed significant differences between the groups. Our results suggest that generally used histological parameters are often insufficient to differentiate an incidental myocarditis from a (potentially) significant one.

Discussion

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Cite This Study

Long et al. (2021) conducted a cohort in Myocardial inflammation (n=79). Diffuse myocardial inflammation vs. Focal or non-diffuse myocardial inflammation was evaluated on Presence of diffuse acute myocarditis across cause of death groups (p=0.021). Only a diffuse increase of inflammatory cells could reliably discriminate between an incidental presence of myocardial inflammation and a potentially significant one as the cause of death.

synapsesocial.com/papers/6a12534145487b7639a64054 https://doi.org/10.1080/20961790.2021.1989793

Topics

Myocarditis

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The histopathological spectrum of myocardial inflammation in relation to circumstance of death: a retrospective cohort study in clinical and forensic autopsies

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

The histopathological spectrum of myocardial inflammation in relation to circumstance of death: a retrospective cohort study in clinical and forensic autopsies

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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