Postmortem diagnosis of myocardial ischemia remains a challenge in forensic pathology, as traditional methods like autopsy and histology may not always provide conclusive results. Cardiac troponins, specifically cTnI and cTnT, are well-established biomarkers for myocardial injury in living patients, but their role in postmortem ischemia diagnosis is still under investigation. This systematic review aims to evaluate the role of troponins in diagnosing myocardial ischemia in postmortem cases, focusing on the diagnostic accuracy, sample types, and the influence of the postmortem interval (PMI). A systematic search on PubMed NCBI was conducted to identify studies published between 2000 and 2024 that evaluated the use of cTnI and cTnT in postmortem myocardial ischemia diagnosis. The studies were assessed for their sample types, methods of troponin quantification, sensitivity, specificity, and the impact of PMI on the stability of troponin levels. The review included 13 studies that utilized various sample types, including serum, femoral blood, and pericardial fluid. cTnT was found to be more reliable than cTnI, particularly in pericardial fluid, with shorter PMIs (typically under 48 h) showing higher sensitivity and specificity for myocardial ischemia. Pericardial fluid provided the most consistent results, followed by serum and femoral blood. Studies also highlighted that longer PMIs negatively affected the reliability of troponin measurements due to postmortem degradation. Cardiac troponins, especially cTnT, are valuable biomarkers for diagnosing myocardial ischemia postmortem, particularly when measured in pericardial fluid and within a short PMI. The use of multimarker strategies and the development of standardized cut-off values are needed to improve the accuracy of troponin measurements in forensic pathology. Future research should focus on standardizing diagnostic thresholds, improving assay sensitivity, and exploring new sample types and imaging techniques to enhance postmortem cardiovascular diagnostics.
The Role of Cardiac Troponins in Postmortem Diagnosis of Myocardial Ischemia: A Systematic Review
Sacco M. A.;Gualtieri S.;Grimaldi G.;Monterossi M. D.;Aquila V. R.;Tarallo A. P.;Verrina M. C.;Ranno F.;Gratteri S.;Aquila I.
2025-01-01
Abstract
Postmortem diagnosis of myocardial ischemia remains a challenge in forensic pathology, as traditional methods like autopsy and histology may not always provide conclusive results. Cardiac troponins, specifically cTnI and cTnT, are well-established biomarkers for myocardial injury in living patients, but their role in postmortem ischemia diagnosis is still under investigation. This systematic review aims to evaluate the role of troponins in diagnosing myocardial ischemia in postmortem cases, focusing on the diagnostic accuracy, sample types, and the influence of the postmortem interval (PMI). A systematic search on PubMed NCBI was conducted to identify studies published between 2000 and 2024 that evaluated the use of cTnI and cTnT in postmortem myocardial ischemia diagnosis. The studies were assessed for their sample types, methods of troponin quantification, sensitivity, specificity, and the impact of PMI on the stability of troponin levels. The review included 13 studies that utilized various sample types, including serum, femoral blood, and pericardial fluid. cTnT was found to be more reliable than cTnI, particularly in pericardial fluid, with shorter PMIs (typically under 48 h) showing higher sensitivity and specificity for myocardial ischemia. Pericardial fluid provided the most consistent results, followed by serum and femoral blood. Studies also highlighted that longer PMIs negatively affected the reliability of troponin measurements due to postmortem degradation. Cardiac troponins, especially cTnT, are valuable biomarkers for diagnosing myocardial ischemia postmortem, particularly when measured in pericardial fluid and within a short PMI. The use of multimarker strategies and the development of standardized cut-off values are needed to improve the accuracy of troponin measurements in forensic pathology. Future research should focus on standardizing diagnostic thresholds, improving assay sensitivity, and exploring new sample types and imaging techniques to enhance postmortem cardiovascular diagnostics.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
