NECROPSY STUDY OF THE ASSOCIATION BETWEEN SUDDEN CARDIAC DEATH, CARDIAC ISOENZYMES AND CONTRACTION BAND NECROSIS

Aims-To assess whether a quantitative analysis of myocardial contracti on bands could aid the postmortem identification of early myocardial i nfarction, especially if used in conjunction with cardiac isoenzyme ac tivities. Methods-Sixty four coroner's necropsies were grouped by gros s and histological findings into 26 cases of definite non-cardiac deat h, 12 cases of definite myocardial infarction and 26 cases in which th ere was occlusive coronary artery atheroma, but no demonstrable eviden ce of infarction. Using multiple sections of left ventricular myocardi um stained with Heidenhain's iron haematoxylin, the number of myocardi al cells containing contraction bands per unit area was quantified. Th e results were analysed statistically using logistic regression, and w ere then compared and combined with results from the statistical analy sis of postmortem cardiac isoenzymes that had recently been undertaken on the same cases. Results-The number of cells containing contraction bands per unit area was higher in cases of definite myocardial infarc tion compared with those of non-cardiac deaths. In addition, cases of occlusive coronary artery atheroma only could be identified, indicatin g the presence of early myocardial infarction. The accuracy of this id entification could be improved by combining these results with the res ults from the statistical analysis of postmortem cardiac isoenzymes.Co nclusion-The quantitative assessment of myocardial contraction band ne crosis can provide useful additional information in cases of sudden de ath, where myocardial infarction is suspected but not identified on ro utine histological staining. The value of the information obtained is increased when used in conjunction with the postmortem measurement of cardiac isoenzyme activities.