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Published in: Forensic Science, Medicine and Pathology 2/2016

01-06-2016 | Technical Report

Cardiac troponin T determination by a highly sensitive assay in postmortem serum and pericardial fluid

Authors: Lucas González-Herrera, Aurora Valenzuela, Valentín Ramos, Antonia Blázquez, Enrique Villanueva

Published in: Forensic Science, Medicine and Pathology | Issue 2/2016

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Abstract

Purpose

The main objective of this study was to test, for the first time, a highly sensitive cardiac troponin T (cTnThs) assay in postmortem serum and pericardial fluid and to evaluate cardiac troponin T (cTnT) levels and their stability after death at different postmortem intervals, in an attempt to determine the viability of the cTnThs assay in the postmortem diagnosis of the cause of death.

Methods

cTnT levels were determined in serum and pericardial fluid samples taken from 58 cadavers at known postmortem intervals, whose causes of death were categorized into the following groups: (1) sudden cardiac deaths, (2) multiple trauma, (3) mechanical asphyxia, and (4) other natural deaths. cTnT was determined by inmunoassay, using the Troponin T highly sensitive STAT assay (Roche®).

Results

Average cTnT levels measured by a highly sensitive assay in postmortem serum were markedly higher than clinical serum levels. Moreover, similar results, higher cTnT levels in postmortem pericardial fluid, were obtained when compared to levels found in pericardial fluid taken from two living patients during coronary artery bypass surgery. cTnT levels in both postmortem fluids remained stable for up to 34 h after death. No differences in cTnT levels in either postmortem fluid by sex and age were detected. Levels of cTnT found in pericardial fluid in the other natural deaths group were significantly lower than the cTnT levels found in that postmortem fluid from any of the other causes of death groups.

Conclusion

It is therefore reasonable to conclude that determination of cTnT by a highly sensitive assay in pericardial fluid can provide forensic pathologists with a complementary test to the diagnosis of cause of death.
Literature
1.
go back to reference Twerenbold R, Jaffe A, Reichlin T, Reiter M, Mueller C. High-sensitive troponin T measurements: what do we gain and what are the challenges? Eur Heart J. 2012;33:579–86.CrossRefPubMed Twerenbold R, Jaffe A, Reichlin T, Reiter M, Mueller C. High-sensitive troponin T measurements: what do we gain and what are the challenges? Eur Heart J. 2012;33:579–86.CrossRefPubMed
2.
go back to reference Eggers KM, Venge P, Lindahl B. High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain. Clin Chim Acta. 2012;413:1135–40.CrossRefPubMed Eggers KM, Venge P, Lindahl B. High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain. Clin Chim Acta. 2012;413:1135–40.CrossRefPubMed
3.
go back to reference Jaffe AS, Ordonez-Llanos J. High sensitivity troponin in chest pain and acute coronary syndromes. A step forward? Rev Esp Cardiol. 2010;63:763–9.CrossRefPubMed Jaffe AS, Ordonez-Llanos J. High sensitivity troponin in chest pain and acute coronary syndromes. A step forward? Rev Esp Cardiol. 2010;63:763–9.CrossRefPubMed
4.
go back to reference Keller T, Zeller T, Peetz D, et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med. 2009;361:868–77.CrossRefPubMed Keller T, Zeller T, Peetz D, et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med. 2009;361:868–77.CrossRefPubMed
5.
go back to reference Reichlin T, Hochholzer W, Bassetti S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009;361:858–67.CrossRefPubMed Reichlin T, Hochholzer W, Bassetti S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009;361:858–67.CrossRefPubMed
6.
go back to reference Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581–98.CrossRefPubMed Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581–98.CrossRefPubMed
7.
go back to reference Thygesen K, Mair J, Katus H, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010;31:2197–204.CrossRefPubMed Thygesen K, Mair J, Katus H, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010;31:2197–204.CrossRefPubMed
8.
go back to reference Remmer S, Kuudeberg A, Tonisson M, Lepik D, Vali M. Cardiac troponin T in forensic autopsy cases. Forensic Sci Int. 2013;233:154–7.CrossRefPubMed Remmer S, Kuudeberg A, Tonisson M, Lepik D, Vali M. Cardiac troponin T in forensic autopsy cases. Forensic Sci Int. 2013;233:154–7.CrossRefPubMed
9.
go back to reference Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006;48:1–11.CrossRefPubMed Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006;48:1–11.CrossRefPubMed
10.
go back to reference Zhu BL, Ishikawa T, Michiue T, et al. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1: Analysis with special regard to traumatic causes of death. Leg Med (Tokyo). 2006;8:86–93.CrossRef Zhu BL, Ishikawa T, Michiue T, et al. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1: Analysis with special regard to traumatic causes of death. Leg Med (Tokyo). 2006;8:86–93.CrossRef
11.
go back to reference Zhu BL, Ishikawa T, Michiue T, et al. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2: Analysis for application in the diagnosis of sudden cardiac death with regard to pathology. Leg Med (Tokyo). 2006;8:94–101.CrossRef Zhu BL, Ishikawa T, Michiue T, et al. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2: Analysis for application in the diagnosis of sudden cardiac death with regard to pathology. Leg Med (Tokyo). 2006;8:94–101.CrossRef
12.
go back to reference Davies SJ, Gaze DC, Collinson PO. Investigation of cardiac troponins in postmortem subjects: comparing antemortem and postmortem levels. Am J Forensic Med Pathol. 2005;26:213–5.CrossRefPubMed Davies SJ, Gaze DC, Collinson PO. Investigation of cardiac troponins in postmortem subjects: comparing antemortem and postmortem levels. Am J Forensic Med Pathol. 2005;26:213–5.CrossRefPubMed
13.
14.
go back to reference Aldous SJ, Richards M, Cullen L, Troughton R, Than M. Diagnostic and prognostic utility of early measurement with high-sensitivity troponin T assay in patients presenting with chest pain. CMAJ. 2012;184:E260–8.CrossRefPubMedPubMedCentral Aldous SJ, Richards M, Cullen L, Troughton R, Than M. Diagnostic and prognostic utility of early measurement with high-sensitivity troponin T assay in patients presenting with chest pain. CMAJ. 2012;184:E260–8.CrossRefPubMedPubMedCentral
15.
go back to reference Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2010;56:254–61.CrossRefPubMed Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2010;56:254–61.CrossRefPubMed
16.
go back to reference Chugh SS, Reinier K, Teodorescu C, et al. Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis. 2008;51:213–28.CrossRefPubMedPubMedCentral Chugh SS, Reinier K, Teodorescu C, et al. Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis. 2008;51:213–28.CrossRefPubMedPubMedCentral
17.
go back to reference Michaud K, Grabherr S, Jackowski C, Bollmann MD, Doenz F, Mangin P. Postmortem imaging of sudden cardiac death. Int J Legal Med. 2014;128:127–37.CrossRefPubMed Michaud K, Grabherr S, Jackowski C, Bollmann MD, Doenz F, Mangin P. Postmortem imaging of sudden cardiac death. Int J Legal Med. 2014;128:127–37.CrossRefPubMed
18.
go back to reference Felker GM, Shaw LK, O’Connor CM. A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol. 2002;39:210–8.CrossRefPubMed Felker GM, Shaw LK, O’Connor CM. A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol. 2002;39:210–8.CrossRefPubMed
19.
go back to reference Perez-Carceles MD, Noguera J, Jimenez JL, Martinez P, Luna A, Osuna E. Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease. Forensic Sci Int. 2004;142:1–7.CrossRefPubMed Perez-Carceles MD, Noguera J, Jimenez JL, Martinez P, Luna A, Osuna E. Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease. Forensic Sci Int. 2004;142:1–7.CrossRefPubMed
20.
go back to reference Batalis NI, Marcus BJ, Papadea CN, Collins KA. The role of postmortem cardiac markers in the diagnosis of acute myocardial infarction. J Forensic Sci. 2010;55:1088–91.CrossRefPubMed Batalis NI, Marcus BJ, Papadea CN, Collins KA. The role of postmortem cardiac markers in the diagnosis of acute myocardial infarction. J Forensic Sci. 2010;55:1088–91.CrossRefPubMed
21.
go back to reference Campobasso CP, Dell’Erba AS, Addante A, Zotti F, Marzullo A, Colonna MF. Sudden cardiac death and myocardial ischemia indicators: a comparative study of four immunohistochemical markers. Am J Forensic Med Pathol. 2008;29:154–61.CrossRefPubMed Campobasso CP, Dell’Erba AS, Addante A, Zotti F, Marzullo A, Colonna MF. Sudden cardiac death and myocardial ischemia indicators: a comparative study of four immunohistochemical markers. Am J Forensic Med Pathol. 2008;29:154–61.CrossRefPubMed
22.
go back to reference Hougen HP, Valenzuela A, Lachica E, Villanueva E. Sudden cardiac death: a comparative study of morphological, histochemical and biochemical methods. Forensic Sci Int. 1992;52:161–9.CrossRefPubMed Hougen HP, Valenzuela A, Lachica E, Villanueva E. Sudden cardiac death: a comparative study of morphological, histochemical and biochemical methods. Forensic Sci Int. 1992;52:161–9.CrossRefPubMed
23.
go back to reference Jasra SK, Badian C, Macri I, Ra P. Recognition of early myocardial infarction by immunohistochemical staining with cardiac troponin-I and complement C9. J Forensic Sci. 2012;57:1595–600.CrossRefPubMed Jasra SK, Badian C, Macri I, Ra P. Recognition of early myocardial infarction by immunohistochemical staining with cardiac troponin-I and complement C9. J Forensic Sci. 2012;57:1595–600.CrossRefPubMed
24.
go back to reference Partemi S, Berne PM, Batlle M, et al. Analysis of mRNA from human heart tissue and putative applications in forensic molecular pathology. Forensic Sci Int. 2010;203:99–105.CrossRefPubMed Partemi S, Berne PM, Batlle M, et al. Analysis of mRNA from human heart tissue and putative applications in forensic molecular pathology. Forensic Sci Int. 2010;203:99–105.CrossRefPubMed
25.
go back to reference Gonzalez-Herrera L, Valenzuela A, Marchal JA, Lorente JA, Villanueva E. Studies on RNA integrity and gene expression in human myocardial tissue, pericardial fluid and blood, and its postmortem stability. Forensic Sci Int. 2013;232:218–28.CrossRefPubMed Gonzalez-Herrera L, Valenzuela A, Marchal JA, Lorente JA, Villanueva E. Studies on RNA integrity and gene expression in human myocardial tissue, pericardial fluid and blood, and its postmortem stability. Forensic Sci Int. 2013;232:218–28.CrossRefPubMed
26.
go back to reference Son GH, Park SH, Kim Y, et al. Postmortem mRNA expression patterns in left ventricular myocardial tissues and their implications for forensic diagnosis of sudden cardiac death. Mol Cells. 2014;37:241–7.CrossRefPubMedPubMedCentral Son GH, Park SH, Kim Y, et al. Postmortem mRNA expression patterns in left ventricular myocardial tissues and their implications for forensic diagnosis of sudden cardiac death. Mol Cells. 2014;37:241–7.CrossRefPubMedPubMedCentral
27.
go back to reference Chen JH, Inamori-Kawamoto O, Michiue T, Ikeda S, Ishikawa T, Maeda H. Cardiac biomarkers in blood, and pericardial and cerebrospinal fluids of forensic autopsy cases: a reassessment with special regard to postmortem interval. Leg Med (Tokyo). 2015;17(5):343–50.CrossRef Chen JH, Inamori-Kawamoto O, Michiue T, Ikeda S, Ishikawa T, Maeda H. Cardiac biomarkers in blood, and pericardial and cerebrospinal fluids of forensic autopsy cases: a reassessment with special regard to postmortem interval. Leg Med (Tokyo). 2015;17(5):343–50.CrossRef
28.
go back to reference Zhu BL, Ishikawa T, Michiue T, et al. Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy. Leg Med (Tokyo). 2007;9:241–50.CrossRef Zhu BL, Ishikawa T, Michiue T, et al. Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy. Leg Med (Tokyo). 2007;9:241–50.CrossRef
29.
go back to reference Osuna E, Perez-Carceles MD, Alvarez MV, Noguera J, Luna A. Cardiac troponin I (cTn I) and the postmortem diagnosis of myocardial infarction. Int J Legal Med. 1998;111:173–6.CrossRefPubMed Osuna E, Perez-Carceles MD, Alvarez MV, Noguera J, Luna A. Cardiac troponin I (cTn I) and the postmortem diagnosis of myocardial infarction. Int J Legal Med. 1998;111:173–6.CrossRefPubMed
30.
go back to reference Martinez Diaz F, Rodriguez-Morlensin M, Perez-Carceles MD, Noguera J, Luna A, Osuna E. Biochemical analysis and immunohistochemical determination of cardiac troponin for the postmortem diagnosis of myocardial damage. Histol Histopathol. 2005;20:475–81.PubMed Martinez Diaz F, Rodriguez-Morlensin M, Perez-Carceles MD, Noguera J, Luna A, Osuna E. Biochemical analysis and immunohistochemical determination of cardiac troponin for the postmortem diagnosis of myocardial damage. Histol Histopathol. 2005;20:475–81.PubMed
31.
go back to reference Ramos V, Valenzuela A, Villanueva E, Miranda MT. Antioxidant-related enzymes in myocardial zones and human pericardial fluid in relation to the cause of death. Int J Legal Med. 1997;110:1–4.CrossRefPubMed Ramos V, Valenzuela A, Villanueva E, Miranda MT. Antioxidant-related enzymes in myocardial zones and human pericardial fluid in relation to the cause of death. Int J Legal Med. 1997;110:1–4.CrossRefPubMed
32.
go back to reference Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993;39:561–77.PubMed Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993;39:561–77.PubMed
33.
go back to reference Khalifa AB, Najjar M, Addad F, Turki E, Mghirbi T. Cardiac troponin T (cTn T) and the postmortem diagnosis of sudden death. Am J Forensic Med Pathol. 2006;27:175–7.CrossRefPubMed Khalifa AB, Najjar M, Addad F, Turki E, Mghirbi T. Cardiac troponin T (cTn T) and the postmortem diagnosis of sudden death. Am J Forensic Med Pathol. 2006;27:175–7.CrossRefPubMed
34.
go back to reference Vargas SO, Grudzien C, Tanasijevic MJ. Postmortem cardiac troponin-I levels predict intramyocardial damage at autopsy. J Thromb Thrombolysis. 2008;26:132–7.CrossRefPubMed Vargas SO, Grudzien C, Tanasijevic MJ. Postmortem cardiac troponin-I levels predict intramyocardial damage at autopsy. J Thromb Thrombolysis. 2008;26:132–7.CrossRefPubMed
35.
go back to reference Sapouna R, Gourgiotis D, Athanaselis S, Papadodima S, Spiliopoulou C. Diagnostic value of cardiac troponin I in postmortem diagnosis of myocardial infarction. Am J Forensic Med Pathol. 2013;34:139–41.CrossRefPubMed Sapouna R, Gourgiotis D, Athanaselis S, Papadodima S, Spiliopoulou C. Diagnostic value of cardiac troponin I in postmortem diagnosis of myocardial infarction. Am J Forensic Med Pathol. 2013;34:139–41.CrossRefPubMed
36.
go back to reference Kawamoto O, Michiue T, Ishikawa T, Maeda H. Comprehensive evaluation of pericardial biochemical markers in death investigation. Forensic Sci Int. 2013;224:73–9.CrossRefPubMed Kawamoto O, Michiue T, Ishikawa T, Maeda H. Comprehensive evaluation of pericardial biochemical markers in death investigation. Forensic Sci Int. 2013;224:73–9.CrossRefPubMed
37.
go back to reference Luna A. Is postmortem biochemistry really useful? Why is it not widely used in forensic pathology? Leg Med (Tokyo). 2009;11(Suppl 1):S27–30.CrossRef Luna A. Is postmortem biochemistry really useful? Why is it not widely used in forensic pathology? Leg Med (Tokyo). 2009;11(Suppl 1):S27–30.CrossRef
38.
39.
go back to reference Wang Q, Michiue T, Ishikawa T, Zhu BL, Maeda H. Combined analyses of creatine kinase MB, cardiac troponin I and myoglobin in pericardial and cerebrospinal fluids to investigate myocardial and skeletal muscle injury in medicolegal autopsy cases. Leg Med (Tokyo). 2011;13:226–32.CrossRef Wang Q, Michiue T, Ishikawa T, Zhu BL, Maeda H. Combined analyses of creatine kinase MB, cardiac troponin I and myoglobin in pericardial and cerebrospinal fluids to investigate myocardial and skeletal muscle injury in medicolegal autopsy cases. Leg Med (Tokyo). 2011;13:226–32.CrossRef
40.
go back to reference Peter J, Kirchner A, Kuhlisch E, Menschikowski M, Neef B, Dressler J. The relevance of the detection of troponins to the forensic diagnosis of cardiac contusion. Forensic Sci Int. 2006;160:127–33.CrossRefPubMed Peter J, Kirchner A, Kuhlisch E, Menschikowski M, Neef B, Dressler J. The relevance of the detection of troponins to the forensic diagnosis of cardiac contusion. Forensic Sci Int. 2006;160:127–33.CrossRefPubMed
Metadata
Title
Cardiac troponin T determination by a highly sensitive assay in postmortem serum and pericardial fluid
Authors
Lucas González-Herrera
Aurora Valenzuela
Valentín Ramos
Antonia Blázquez
Enrique Villanueva
Publication date
01-06-2016
Publisher
Springer US
Published in
Forensic Science, Medicine and Pathology / Issue 2/2016
Print ISSN: 1547-769X
Electronic ISSN: 1556-2891
DOI
https://doi.org/10.1007/s12024-016-9749-1

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