Diagnostic Efficacy of Troponin – I qualitative Rapid test in Sudden Cardiac Deaths

Authors

  • P P Kumar Assistant Professor, Department of Forensic Medicine, ACSR Govt. Medical College, SPSR Nellore
  • P R Sabale Professor (Addl.) and Head, Department of Forensic Medicine, Topiwala National Medical College, Mumbai.
  • G P Amonkar Associate Professor,Department of Pathology, Topiwala National Medical College, Mumbai.

DOI:

https://doi.org/10.48165/jiafm.2023.45.2.13

Keywords:

Troponin – I, Acute MI, Sudden deaths

Abstract

Everyone knows by conducting autopsy cause of sudden unexpected death can be established. However due to limitations of staff, budget  and time it forces the autopsy surgeon to triage the cases. Out of which sudden cardiac deaths because of acute myocardial infarction  constitute a significant percentage of caseload. When an autopsy is performed, there may be significant cardiovascular disease but there  will be no gross or histological evidence of an acute myocardial infarct unless the patient survived for few hours. Troponin I (cTnI) done  using peripheral blood was sampled percutaneously before conducting internal examination of each of 60 autopsies. The rapid assay  result, histopathological results were tabulated and subsequently correlated. Out of 30 cases all showed positive result but in 30 controls 11  showed false positive results and 19 showed negative results. This result was statistically significant according to the chi-square test. The  sensitivity of this assay in detecting cardiac-related death was 100%, with a specificity of 63.33%. In the appropriate setting, this rapid  assay for cTnI can provide valuable data supportive of a cardiac-related death. This inexpensive test may best be used in triaging sudden  deaths in persons and may optimize the use of the time and resources of the autopsy pathologist.

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References

Honnekeri BS, Lokhandwala D, Panicker GK, Lokhandwala Y. Sudden Cardiac Death in India: A Growing Concern. J Assoc Physicians India. 2014 Dec;62(12):36-40.

Cohle SD, Sampson BA. The negative autopsy: sudden cardiac death or other? Cardiovasc Pathol. 2001 Sep Oct;10(5):219-22.

Mustafa GH, Gorea RK, Rahman S, Khan MS. Diagnostic efficacy of cardiac troponins in post-mortem examination of acute myocardial infarctions. Int J Eth Trauma Victimology. 2015; 1(1):21-28. 4. Verma AK, Kumar S, Kumar N, Verma RK, Singh M. Study of Coronary Artery Atherosclerosis in Sudden Deaths and Its Medico-legal Relevance (Original Research Paper). J Indian Acad Forensic Med. 2012 April-June; 34(2):0971-0973.

Cina SJ, Li DJ, Chan DW, Boitnott JK, Hruban RH, Smialek JE. Serum concentrations of cardiac troponin I in sudden death: a pilot study. Am J Forensic Med Pathol. 1998 Dec;19(4):324-8.

Etievent JP, Chocron S, Toubin G, Taberlet C, Alwan K, Clement F, et al. Use of cardiac troponin I as a marker of perioperative myocardial ischemia. Ann Thorac Surg. 1995 May;59(5):1192-4. doi:10.1016/0003-4975(95)00129-9.

Remmer S, Kuudeberg A, Tõnisson M, Lepik D, Väli M. Cardiac troponin T in forensic autopsy cases. Forensic Sci Int. 2013 Dec 10;233(1-3):154-7.

Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Bessho Y, 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 Sep;9(5):241-50.

Cina SJ, Brown DK, Smialek JE, Collins KA. A rapid postmortem cardiac troponin T assay: laboratory evidence of sudden cardiac death. Am J Forensic Med Pathol. 2001 Jun;22(2):173-6.

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 Jul;55(4):1088- 91.

Ortiz-Olvera NX, Castellanos-Pallares G, Gómez-Jiménez

ISSN : 0971 - 0973, e - ISSN : 0974 - 0848

LM, Cabrera-Muñoz ML, Méndez-Navarro J, Morán-Villota S, et al. Anatomical cardiac alterations in liver cirrhosis: an autopsy study. Ann Hepatol. 2011 Jul-Sep;10(3):321-6.

Wehmeyer MH, Heuer AJ, Benten D, Püschel K, Sydow K, Lohse AW, Lüth S. High Rate of Cardiac Abnormalities in a Postmortem Analysis of Patients Suffering From Liver Cirrhosis. J Clin Gastroenterol. 2015 Nov-Dec;49(10):866-

Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Oritani S, Kamikodai Y, 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 Mar;8(2):86-93.

Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Kamikodai Y, 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 Mar;8(2):94-101.

Pérez-Cárceles MD, Noguera J, Jiménez JL, Martínez P, Luna A, Osuna E. Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease. Forensic Sci Int. 2004 May 28;142(1):1-7.

Martínez Díaz F, Rodríguez-Morlensín M, Pérez-Cárceles 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 Apr;20(2):475-81.

White HD. Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis? J Am Coll Cardiol. 2011 Jun 14;57(24):2406-8.

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Published

2023-08-12

How to Cite

Kumar , P. P., Sabale , P. R., & Amonkar , G. P. (2023). Diagnostic Efficacy of Troponin – I qualitative Rapid test in Sudden Cardiac Deaths . Journal of Indian Academy of Forensic Medicine, 45(2), 149-152. https://doi.org/10.48165/jiafm.2023.45.2.13