Guidelines for autopsy investigation of sudden cardiac death

Abstract

Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed, and the accurate diagnosis of the causes of sudden cardiac death is now of particular importance. Pathologists are responsible for determining the precise cause of sudden death but there is considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology developed guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate assessment of sudden cardiac death, including not only a protocol for heart examination and histological sampling, but also for toxicology and molecular investigation. Our recommendations apply to university medical centres, regional and district hospitals and all types of forensic medicine institutes. If a uniform method of investigation is adopted throughout the European Union, this will lead to improvements in standards of practice, allow meaningful comparisons between different communities and regions and, most importantly, permit future trends in the patterns of disease causing sudden death to be monitored.

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

“…According to the current recommendations in the field of autopsy practice and cardiovascular pathology [17,18,24,[39][40][41], histological examination of the myocardium should be performed in order to assess the time dependent histological patterns of ischemia. Some pathological findings, such as acute coronary occlusive thrombosis or myocardial rupture, are practically certain to represent the cause of death, whereas, the interpretation of chronic macroscopic findings, such as those described in ischemic heart disease, is more delicate.…”

“…Twenty three cases were retrospectively selected based on their clinical histories that were suggestive of death due to ischemic heart disease (Table 1) The autopsies were performed between 2009 and 2010 in accordance with international guidelines [17,18] by two forensic pathologists, one in training and one certified by the national board. The age of the subjects ranged from 37 and 89 years with a mean of 52.3 ± 12.2.…”

“…Segments of coronary arteries that were deemed to be unperfused or stenosed greater than 75% with CT-angiography were subsequently evaluated histologically as the stenoses greater than 75% or occluded lumen are associated with hemodynamically significant disturbances which lead to myocardial infarction and explain the sudden cardiac death. Above the 75% cut-off, the stenosis is considered as the highly probable cause of death after exclusion of other causes [17].…”

A Clinical Perspective on Sudden Cardiac Death

“…A negative pathological examination suggests a genetic channelopathy. 68 Post-mortem MRI is also a valuable tool for non-invasively documenting pathological findings, such as myocardial infarction or severe myocardial hypertrophy, 69 and post-mortem computed tomography coronary angiography is now possible. 70 Despite every effort, however, nearly half of the causes of cardiac arrest will remain unexplained.…”

The genetics of cardiovascular disease: new insights from emerging approaches

“…The ability to sequence DNA more cheaply and quickly using next-generation platforms is likely to lead to incorporation of genetic information into routine clinical practice almost immediately. For example, in cases of sudden cardiac death, genetic testing is recommended on the index case and family members [100], but the number of genes known to be implicated is large and many families carry novel mutations, making comprehensive testing practically difficult. Rather than laboriously examining these patients for known mutations, all implicated or candidate genes could be rapidly 're-sequenced' to provide a more detailed assessment of genetic causation, and to identify previously unknown mutations in regulatory or other non-coding elements.…”