A study of various morphologic variables and troponin I in pericardial fluid as possible discriminators of sudden cardiac death

Pathologists frequently examine victims of sudden cardiac death. In some ca ses, a firm diagnosis of cardiac-related death can be made based on conclus ive gross and histologic findings. In many other cases, we find evidence su pportive of, but not diagnostic of, cardiac death (e.g., atherosclerotic co ronary artery disease, cardiomegaly, myocardial scarring). A final cohort c onsists of cases of sudden death with minimal to mild cardiac disease, no o ther significant pathology, and negative toxicologic studies. This prospect ive study compared 38 cardiac-related deaths with 52 control cases with res pect to concentrations of pericardial cardiac troponin I (cTnI), heart weig ht, evidence of old and/or recent myocardial injury, and presence of signif icant coronary artery disease. The influence of documented chest trauma and /or perimortem cardiopulmonary resuscitation (CPR) on levels of cTnI was al so analyzed. Even though median cTnI levels were significantly higher in ca rdiac deaths than in controls (p = .003), cTnI was not found to be a signif icant predictor of cardiac deaths, as determined by discriminant analysis ( p = .52). Heart weight >500 g, evidence of old and recent myocardial injury , and significant coronary artery disease were seen statistically more ofte n in cardiac deaths than in controls (p less than or equal to .005 in each case), and median age was significantly higher in cardiac deaths than in co ntrols (p = .001). Based on a stepwise logistic regression model, significa nt coronary artery disease, old and recent myocardial injury, and heart wei ght >500 g were found to contribute significantly to the prediction of card iac death. Finally, neither chest injury nor CPR significantly affected con centrations of cTnI in pericardial fluid. These data confirm that the prese nce of acute and remote myocardial injury, significant coronary artery dise ase, and cardiomegaly (heart weight >500 g) strongly supports the diagnosis of a cardiac-related death. In contrast to a recently published report, we do not find that elevated concentrations of cTnI in pericardial fluid are strong indicators of cardiac-related deaths using our methodology.