Sala Grande - 19th IAFS World Meeting - 9th WPMO Triennial Meeting

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19 th IAFS WORLD MEETING
9 th WPMO TRIENNIAL MEETING
5 th MAFS MEETING
BNP SERUM AND CTNI LEVELS IN THE POSTMORTEM DIAGNOSIS OF CONGESTIVE AND
ISCHEMIC CARDIAC DISEASE
Author(s): Osuna E 1 ; Pérez-Cárceles M 1 ; Navarro E 2 ; Cardona B 2 ; Giner S 2 ; Devesa M 2 ; Bañón R 3
Institution(s): 1 DEPARTMENT OF FORENSIC MEDICINE - UNIVERSITY OF MURCIA, SPAIN; 2 INSTITUTE OF LEGAL MEDICINE, ALICANTE,
SPAIN; 3 INSTITUTE OF LEGAL MEDICINE, MURCIA, SPAIN; 4 INSTITUTE OF LEGAL MEDICINE, MURCIA, SPAIN
Introduction: The forensic assessment of sudden cardiac death is notoriously difficult. The limitations of autopsy in the diagnosis of
death due to heart disease, ischemic or not, are well known. In clinical practice, natriuretic peptides have been introduced as
biomarkers of cardiac function. B-type natriuretic peptide (BNP) is a vasoactive neurohormone secreted by cardiomyocytes in response
to pressure and volume overload.
Materials and Methods: We studied 133 cadavers (96 males and 37 females) from forensic necropsies. The mean age of the subjects
was 58.4 years (SD 17.7 years, range 15-96 years). Cases were selected according to the post-mortem interval and circumstances of
death. According to the cause of death, cases were divided into two main groups, (1) cardiac deaths (n=60) and (2) control group (n=73).
In the cardiac deaths group, two categories were established according to morphological features of the heart: (1a) ‘ischemic deaths’
(N=37) and , when evidence of significant stenosis in one or more of the epicardial coronary arteries was found and HE staining showed
specific signs of necrosis, and (1b) ‘congestive heart’ (n=23), when the histological pattern suggests failure of the heart pump, including
dilated cardiomegaly, myocardial degeneration and ventricular dilatation. Serum samples were measured in duplicate for BNP, cTnI.
Histological studies with hematoxylin-eosin (HE) staining and Masson’s trichrome staining in formalin-fixed paraffin sections were
performed. Statistically significant correlations were determined between different variables and discriminant analysis was applied. A
non-parametric test (Kruskal-Wallis Test) was used to compare groups. Also specific contrasts for each variable grouped according to the
diagnostic categories were carried out using the Mann-Withney Test. For each of the variables studied a ROC (receiver operating
characteristic) curve was drawn and the area under the curve was measured using a non-parametric method.
Results: No statistically significant correlations were obtained between the levels of the biochemical markers analyzed in serum and
the post-mortem interval or the use of cardiopulmonary resuscitation for either group. The levels of cTnI (P