Evaluation of postmortem measurement of NT-proBNP as a marker for cardiac function

Abstract

Clinical biomarkers of cardiac function could also be monitored postmortem. Among the natriuretic peptides, the aminoterminal portion of pro-brain natriuretic peptide (NT-proBNP) appears to be a more reliable postmortem tool than the BNP, owing to its longer half-life and greater stability. In living persons, NT-proBNP is considered to be a marker of heart failure, and its level rises after cardiac ischemia. The goal of this study was first to evaluate the postmortem stability of NT-proBNP, then to measure the NT-proBNP levels in postmortem cases of heart failure related to coronary ischemia. The goal of this study was also to evaluate the correlations between different specimens collected at autopsy (e.g. blood, serum, vitreous humor and pericardial fluid). The study included 96 cases, which were classified into 4 groups according to the autopsy and histological findings. The NT-proBNP levels were significantly higher in individuals who had suffered from chronic cardiac ischemia, with or without acute coronary events, than in either control cases or those who had suffered from acute thromboembolism or acute rupture of a plaque without chronic cardiac ischemia. The highest levels were registered in individuals who had suffered from acute coronary thromboembolism in association with chronic coronary ischemia. Good correlations in the NT-proBNP levels for the different specimens were observed between samples of femoral blood, serum, and pericardial fluid. Our data indicated that postmortem measurements of NT-proBNP are reliable and compatible with clinical findings.

Procalcitonin and C-reactive protein in pericardial fluid for postmortem diagnosis of sepsis

“…In medico-legal literature, total ketone body and 3-β-hydroxybutyrate concentrations, as well as insulin, Cpeptide, electrolytes, renal function markers, serotonin and markers of cardiac function have been studied in the pericardial fluid by several authors [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Positive correlations between blood and pericardial fluid ketone body levels have been shown by Pounder [18].…”

“…They emphasised the usefulness of the comparison between blood and pericardial fluid values to confirm the existence of persistent metabolic disorders preceding the death and obtain information pertaining to survival time. Furthermore, measurements of cardiac biomarkers [24][25][26][27][28][29][30][31] in pericardial fluid have been indicated as useful in the investigation of myocardial damage severity.…”

“…Pericardial fluid has been used in forensic practice for several applications to measure different markers, including glucose, ketone bodies, calcium, sodium, potassium, magnesium, urea nitrogen, creatinine, uric acid, markers of myocardial ischemia and cardiac function, insulin, C-peptide and serotonin [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Pericardial fluid levels have been found to be as reliable as blood levels for some of these parameters, thus suggesting that this substrate could be used for postmortem analyses when postmortem biochemical investigations are required to circumstantiate the pathogenesis of death and sufficient amounts of blood are unavailable.…”

A sudden cardiac death induced by sildenafil and sexual activity in an HIV patient with drug interaction, cardiac early repolarization, and arrhythmogenic right ventricular cardiomyopathy

“…Moreover, sexual activity and sildenafil intake would have induced acute heart failure, possibly related to arrhythmia, in this patient with the multiple SCD risks. High peripheral blood NT-proBNP levels support a diagnosis of acute heart failure because its reliability in postmortem diagnoses has been established [10]. The histological findings of cardiomyocyte thinning and waviness could reflect contractile dysfunction in heart failure.…”

Postmortem chemistry update part II

“…Michaud et al [60] investigated the postmortem stability and levels of NT-proBNP in 96 forensic cases classified into four groups according to autopsy and histological findings (acute coronary ischemia, 18 cases; acute and chronic coronary ischemia, 13 cases; chronic coronary ischemia, 25 cases; and control group, 40 cases). NTproBNP levels in pericardial fluid, femoral blood, and postmortem serum from femoral blood were similar, suggesting that any of these fluids could be used for postmortem testing, whereas NT-proBNP vitreous levels were of no value.…”