Diagnostic value of high-sensitivity troponin T in postmortem diagnosis of sudden cardiac death.

INTRODUCTION: Ischemic heart disease is the most common cause of sudden cardiac death. By autopsy, there may be no histologic evidence of acute myocardial damage few hours after death. The use of cardiac troponins in the postmortem diagnosis of sudden cardiac death is well known in the forensic setting. However, high-sensitivity cardiac troponin T (Hs-TnT) assay in cadaver fluids was tested in few studies. The aim of this study is to assess the diagnostic value of postmortem dosage of Hs-TnT in the diagnosis of sudden cardiac death. MATERIAL AND METHODS: Our study is prospective, dealing with cadavers autopsied at the Department of Forensic Medicine of the University Hospital Habib Bourguiba of Sfax-Tunisia from December 2016 to April 2018. Were excluded from the study resuscitated cases, severely traumatized victims and cadavers that were examined more than 36 h after death. Levels of Hs-TnT were measured in pericardial fluid, cardiac blood and peripheral blood. RESULTS: A total of 80 cases were identified with an average age of 44.5 ± 19 years. Hs-TnT levels in pericardial fluid and heart blood were correlated significantly between cardiac and non-cardiac groups with a p-value respectively at 0.14 and 0.04. Receiver-operator characteristic curves analysis showed that the pericardial fluid had the best sensibility (75%) and specificity (64%) with a cut-off level at 17.72 ng/ml and an area under the curve at 0.747. We found also a significant correlation between postmortem interval and Hs-TnT levels in pericardial fluid, cardiac and peripheral blood. CONCLUSION: Our data indicate that determination of cardiac troponin T by a highly sensitive assay in pericardial fluid may be a powerful aid in the postmortem diagnosis of sudden cardiac death.

Forensic examination after exhumation: Contribution and difficulties after more than thirty years of burial.

We report a case of a Tunisian footballer who was found dead abroad under suspicious circumstances. The cause of death was, originally, attributed to a lightning strike. The corpse was buried without/autopsy. Over thirty years later, the family requested the exhumation to verify the identity and the cause of death. The exhumation was performed in 2011. DNA profiling from teeth and femur bone samples confirmed the identity of the deceased. The dry bone study revealed defects in the skull and the pelvis evoking firearm injuries. Post-mortem CT with three-dimensional (3-D) reconstruction allowed to confirm the characteristics of firearms injuries and to speculate about the number and the trajectories of potential shots. Nevertheless, the vitality of these injuries as well as the eventual fatal shot and the shooting distance could not be determined. Likewise, the type of the eventual weapon could not be clarified as there were no bullets or any metallic projectile fragments. Despite all doubts, the forensic explorations have allowed to verify the identity of the deceased, to evoke firearms injuries and, mainly, to deny the proposed cause of death after more than thirty years of burial. Moreover, the loss of soft tissues and bone fragility were the major obstacles.