Journal
LEGAL MEDICINE
Volume 17, Issue 5, Pages 343-350Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.legalmed.2015.03.007
Keywords
Forensic biochemistry; Blood; Body fluid; Cardiac marker; Myocardial injury; Postmortem interval
Categories
Funding
- Japan Society for the Promotion of Science
- Ministry of Education, Culture, Sports, Science, and Technology, Japan [22590642]
- Grants-in-Aid for Scientific Research [22590642] Funding Source: KAKEN
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Previous studies suggested possible application of postmortem biochemistry of myocardial biomarkers to the investigation of sudden cardiac death; however, differences from clinical findings should be considered in autopsy materials. The present study involved a comprehensive investigation of cardiac troponin T and I (cTnT and cTnI), and creatine kinase MB (CK-MB) in cardiac and peripheral external iliac venous blood, pericardial fluid (PCF) and cerebrospinal fluid (CSF) for reassessment, with special regard to the estimated postmortem interval in relation to the cause of death, reviewing a large number of forensic autopsy cases (n = 1923). These cardiac biomarkers showed cause-of-death- and postmortem-time-dependent differences: blood and PCF levels of each marker were higher in hyperthermia (heatstroke), bathwater drowning and chronic congestive heart disease in cases of postmortem interval (PMI) <12 h. After 12 h postmortem, these markers were also higher in fatal drug abuse, spontaneous cerebral/subarachnoid bleeding, electrocution and pulmonary embolism. In addition, most other causes of death, including ischemic heart disease, showed substantial elevations, while these markers remained low in acute hemorrhagic death from sharp instrument injury, hypothermia (cold exposure) and sea-/freshwater drowning during PMI of <48 h. CSF cTnI and CK-MB showed similar findings. There was no difference between myocardial infarction and other causes of death to be discriminated, including asphyxiation, drowning and fire fatality. These findings are similar to clinical observations in critical ill patients, suggesting that elevated cardiac biomarkers cannot be a specific finding for death from acute ischemic heart disease, but indicate the severity of myocardial injury in postmortem investigation. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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