Key result
Pericardial fluid cardiac troponin I was not a significant predictor of cardiac death (p=0.52), whereas significant coronary artery disease, myocardial injury, and heart weight >500 g were.
Why the study?
Do pericardial fluid cTnI levels and morphologic variables accurately discriminate sudden cardiac death from non-cardiac death?
Case-Control (n=90)
Do pericardial fluid cTnI levels and morphologic variables accurately discriminate sudden cardiac death from non-cardiac death?
Morphologic findings such as cardiomegaly and coronary artery disease are strong predictors of sudden cardiac death, while pericardial fluid cTnI is not a reliable independent indicator.
Diagnostic uncertainty persists in sudden deaths lacking definitive cardiac pathology; leaves open need for refined criteria and further investigation.
Pathologists frequently examine victims of sudden cardiac death. In some cases, a firm diagnosis of cardiac-related death can be made based on conclusive gross and histologic findings. In many other cases, we find evidence supportive of, but not diagnostic of, cardiac death (e.g., atherosclerotic coronary artery disease, cardiomegaly, myocardial scarring). A final cohort consists of cases of sudden death with minimal to mild cardiac disease, no other significant pathology, and negative toxicologic studies. This prospective study compared 38 cardiac-related deaths with 52 control cases with respect to concentrations of pericardial cardiac troponin I (cTnI), heart weight, evidence of old and/or recent myocardial injury, and presence of significant coronary artery disease. The influence of documented chest trauma and/or perimortem cardiopulmonary resuscitation (CPR) on levels of cTnI was also analyzed. Even though median cTnI levels were significantly higher in cardiac deaths than in controls (p = .003), cTnI was not found to be a significant predictor of cardiac deaths, as determined by discriminant analysis (p = .52). Heart weight >500 g, evidence of old and recent myocardial injury, and significant coronary artery disease were seen statistically more often in cardiac deaths than in controls (p < or = .005 in each case), and median age was significantly higher in cardiac deaths than in controls (p = .001). Based on a stepwise logistic regression model, significant coronary artery disease, old and recent myocardial injury, and heart weight >500 g were found to contribute significantly to the prediction of cardiac death. Finally, neither chest injury nor CPR significantly affected concentrations of cTnI in pericardial fluid. These data confirm that the presence of acute and remote myocardial injury, significant coronary artery disease, and cardiomegaly (heart weight >500 g) strongly supports the diagnosis of a cardiac-related death. In contrast to a recently published report, we do not find that elevated concentrations of cTnI in pericardial fluid are strong indicators of cardiac-related deaths using our methodology.
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Cina et al. (1999) conducted a case-control in Sudden cardiac death (n=90). Pericardial cardiac troponin I (cTnI) and morphologic variables vs. Control cases (non-cardiac deaths) was evaluated on Prediction of cardiac death (p=0.52). Pericardial fluid cardiac troponin I was not a significant predictor of cardiac death (p=0.52), whereas significant coronary artery disease, myocardial injury, and heart weight >500 g were.
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