Morphological identification of right ventricular failure in cases of fatal pulmonary thromboembolism

Fracasso, Tony; Pfeiffer, Heidi; Sauerland, Cristina; Schmeling, Andreas

doi:10.1007/s00414-010-0486-9

Cited by 18 publications

(16 citation statements)

References 31 publications

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“…In groups 2 and 3, if necroses were detected in both ventricles, they were similarly distributed in both cardiac chambers or prevalent at the left one. We observed this phenomenon in cases of severe pulmonary fat embolism and pulmonary thromboembolism [22,23] compared to controls. Similarly, also in cases of CO intoxications, the most important parameter to evaluate the degree of the involvement of the cardiac chambers is to compare the extension of the damage in both ventricles.…”

Section: Discussionmentioning

confidence: 75%

Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of carbon monoxide poisoning

et al. 2010

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Even if there is clinical evidence that carbon monoxide poisoning determines cardiac damage, the literature on the cardiac pathomorphology in such cases is scarce. We investigated the immunohistochemical expression of two known markers of fresh cardiac damage, fibronectin and the terminal complement complex C5b-9, in both cardiac ventricles in 26 cases of CO intoxication (study group, 15 ♀, 11 ♂, mean age 47 years, mean COHb level 65.9%, min. 51%, max. 85%) compared to a group of 23 cases of hanging (n = 23, 4♀, 19♂, mean age 42 years) as well as to 25 cases of myocardial infarction (n = 25, 13♀, 12♂, mean age 64 years). Fresh cardiac damage was detected with the antibody fibronectin in cases of CO poisoning and was prevalently localised at the right ventricle.

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Section: Discussionmentioning

confidence: 75%

Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of carbon monoxide poisoning

et al. 2010

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“…We have recently proposed an immunohistochemical method for the detection of prevalent ischemic damage at the right ventricle, determining acute right ventricular failure and death in cases of severe fat embolism and pulmonary thromboembolism [11,12].…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of fatal ethanol intoxication

et al. 2011

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Data from the literature indicate that the pulmonary pressure rises in cases of ethanol intake. We have recently proposed a method for the detection of prevalent right ventricular damage in cases of fatal pulmonary thromboembolism and pulmonary fat embolism. In the present study, we compared the expression of the antibodies against fibronectin and C5b-9 in 19 cases of lethal alcohol intoxications (study group: 5 females, 14 males, mean age 46 years, mean blood ethanol concentration 3.5‰, min. 2.11‰, max. 5.31‰) to a group of 26 cases of fatal pulmonary thromboembolism (PE; group 2: 16 females, 10 males, mean age 56 years). Moreover, a group of 15 cases of hanging (group 3: 5 females, 10 males, mean age 50 years) as well as a group of 18 cases of myocardial infarction (group 4: 5 females, 13 males, mean age 61 years) were investigated as examples of typical cardiac damage due to global hypoxia during agony and ischemic damage, respectively. The results of this study show that fresh cardiac damage can be detected at both ventricles in cases of fatal ethanol intoxication with the antibody against fibronectin. The damage is prevalently localised at the right ventricle (RV), as already observed in cases of acute pulmonary hypertension determining right heart failure. The degree of damage at the RV in cases of ethanol intoxications is lower than the one observed in cases of fatal PE.

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“…This is not due to an inappropriate choice of a cut-off point set at 220 pg/mL, as the area under the receiver operating curve also shows low predictive ability (AUC = 65.4%). For this reason, it is suggested to use the standard macro- and microscopical methods to detect heart failure at post mortem examination, eventually validated by immunohistochemical studies [ 42 , 43 ]. Conversely, in putrefied bodies, where autopsy is limited, increased NT-proBNP blood levels can give indication about the (natural) manner of death, in the absence of traumatic lesions during radiological examination.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination

et al. 2011

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NT-proBNP, a marker of cardiac failure, has been shown to be stable in post mortem samples. The aim of this study was to assess the accuracy of NT-proBNP to detect heart failure in the forensic setting. One hundred sixty-eight consecutive autopsies were included in the study. NT-proBNP blood concentrations were measured using a chemiluminescent immunoassay kit. Cardiac failure was assessed by three independent forensic experts using macro- and microscopic findings complemented by information about the circumstances of body discovery and the known medical story. Area under the receiving operator curve was of 65.4% (CI 95%, from 57.1 to 73.7). Using a standard cut-off value of >220 pg/mL for NT-proBNP blood concentration, heart failure was detected with a sensitivity of 50.7% and a specificity of 72.6%. NT-proBNP vitreous humor values were well correlated to the ones measured in blood (r2 = 0.658). Our results showed that NT-proBNP can corroborate the pathological findings in cases of natural death related to heart failure, thus, keeping its diagnostic properties passing from the ante mortem to the post mortem setting. Therefore, biologically inactive polypeptides like NT-proBNP seem to be stable enough to be used in forensic medicine as markers of cardiac failure, taking into account the sensitivity and specificity of the test.Electronic supplementary materialThe online version of this article (doi:10.1007/s00414-011-0581-6) contains supplementary material, which is available to authorized users.

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Morphological identification of right ventricular failure in cases of fatal pulmonary thromboembolism

Cited by 18 publications

References 31 publications

Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of carbon monoxide poisoning

Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of carbon monoxide poisoning

Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of fatal ethanol intoxication

Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination

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