Cardiac troponins and NT-proBNP in the forensic setting: Overview of sampling site, postmortem interval, cardiopulmonary resuscitation, and review of the literature

Abstract

The possible use of biochemical markers in the postmortem diagnosis of myocardial ischemia is well known in the forensic setting, though several issues have limited its widespread adoption. The study presented herein focuses of N-terminal pro-B-type natriuretic peptide, troponin T, and troponin I, and the possible influence due to sampling site chosen, postmortem interval elapsed, and cardiopulmonary resuscitation attempts. Comparisons were performed between antemortem serum levels of these markers and postmortem levels measured in pericardial fluid and postmortem serum samples obtained from different sampling sites (n=16). Levels of these markers were also compared in cases characterized by various postmortem intervals (n=48, consisting of 24 ischemic heart disease cases and 24 controls) as well as in cases with and without cardiopulmonary resuscitation (n=22, consisting of 14 cases of hanging and 8 cases of drug intoxication). Our results indicate that N-terminal pro-B-type natriuretic peptide, troponin T, and troponin I values determined in postmortem serum from femoral blood (collected up to 24h after death) do not differ significantly from those measured in venous blood antemortem serum samples (collected at the upper limbs). In addition, our results reveal that the time elapsed after death should always be taken into consideration when cardiac troponins are measured in postmortem samples. Lastly, our findings reveal the absence of statistically significant differences between levels of the tested biomarkers (in postmortem serum from femoral blood) in cases without cardiopulmonary resuscitation compared to cases with cardiopulmonary resuscitation (at least for postmortem intervals up to 24h).

Luteolin‐mediated Kim‐1/NF‐kB/Nrf2 signaling pathways protects sodium fluoride‐induced hypertension and cardiovascular complications

“…In this study, cardiac complication was also observed consequence of NaF administration as recorded by higher expressions of cardiac troponin I (CTnI). CTnI has been used clinically as diagnostic marker for various cardiovascular dysfunction . It is worth to note that Luteolin co‐administration lowered the expressions of CTnI in comparison to the control and NaF alone treated rats.…”

Intra-individual alterations of serum markers routinely used in forensic pathology depending on increasing post-mortem interval

“…They tried to describe a post-mortem troponin T cut-off of 250 pg/ml 29 . A recent study showed comparable results when investigating cardiac causes of death 39 . Interestingly, the values of our given study often exceeded this previous threshold, but in most of the cases this was already true for the first post-mortem sample.…”

“…Most troponin T studies showed a post-mortem increase, dependent on the post-mortem interval, at least after 48 h 39 , 40 . To the best of our knowledge, only one publication reported the post-mortem results of the same highly-sensitive troponin T assay from Roche Diagnostics and these authors have shown a general post-mortem increase in serum without relation to the underlying causes of death 29 .…”

Evaluation of Agonal Cardiac Function for Sudden Cardiac Death in Forensic Medicine with Postmortem Brain Natriuretic Peptide (BNP) and NT‐proBNP: A Meta‐analysis

“…The results of this postmortem serial biochemical analysis revealed the stability of postmortem NT‐proBNP in pericardial fluid over 24 days when frozen at −20°C . In addition, NT‐proBNP level would not be affected by cardiopulmonary resuscitation during the agonal stage . The statistically higher level of NT‐proBNP in the pericardial fluid indicated postmortem biochemical analysis of NT‐proBNP, rather than BNP, might be more applicable for postmortem evaluation of cardiac function in SCD individuals.…”

“…Brain natriuretic peptide and NT‐proBNP are now widely regarded as significant clinical indicators for the evaluation of cardiac function and the diagnosis of heart failure or cardiac dysfunction in clinical practice . In the past few years, many forensic teams have performed studies on postmortem biochemical analysis of BNP and NT‐proBNP . According to current publications, the BNP and NT‐proBNP levels in different bodily fluids have been reported by several forensic studies to be a useful ancillary tool in postmortem evaluation of cardiac function and diagnosis of cardiac death as well .…”