Postmortem Analysis of Cardiac Troponin I by High-Sensitivity Troponin I Assay
Postmortem High-Sensitivity Troponin I Analysis
Abstract
Postmortem troponin I analysis in autopsy settings can be a valuable tool for forensic pathologists. This study aimed to determine the association of postmortem cardiac troponin levels in cardiac-related death, such as acute myocardial infarction (AMI), and traumatic-related death cases using high-sensitivity cardiac troponin I (hs-CTnl) assays. This retrospective cross-sectional study examined natural and unnatural medicolegal deaths from July 2022 to December 2023. Autopsy reports were reviewed to collect demographic information, autopsy findings, and cardiac troponin levels. The levels of cardiac troponin were analysed using high-sensitivity cardiac troponin assays. A total of 219 cases were analysed, revealing that the median level of hs-CTnl was higher in cardiac death cases (5914.80 pg/ml) compared to non-cardiac deaths (1246.10 pg/ml). Significant differences were noted between the median cardiac troponin level in deaths due to AMI (12145.25 pg/ml) and other causes of death. Receiver operating characteristic analysis showed an area under the curve of 0.723 for hs-cTnI in AMI deaths. Also, various types of traumatic deaths exhibited significant differences in troponin levels. A total of 219 cases were analysed, comprising 84 cardiac deaths, and 135 non-cardiac deaths, which included 59 traumatic death cases. The median level of hs-CTnl was significantly higher in cardiac death cases (5914.80 pg/ml) compared to non-cardiac deaths (1246.10 pg/ml) (p < 0.01). Significant differences were noted between the median cardiac troponin level in deaths due to AMI (12145.25 pg/ml) and other causes of death. Receiver operating characteristic analysis showed an area under the curve of 0.723 for hs-cTnI in AMI deaths. Also, various types of traumatic deaths exhibited significant differences in troponin levels. However, the lack of established reference values requires individual laboratories to establish their own benchmarks to support forensic pathologists in complementary diagnostic testing for postmortem cases. In conclusion, hs-CTnl offers reliable postmortem testing to assist in diagnosing AMI.
Keywords :
High-sensitivity cardiac troponin I; cardiovascular disease; forensic medicine; postmortem biochemistry; trauma,
Abstrak
Analisis troponin I postmortem dalam konteks autopsi boleh dijadikan sebagai alat yang bernilai untuk pakar patologi forensik. Kajian ini bertujuan untuk menentukan hubungan tahap troponin jantung postmortem dalam kematian berkaitan jantung, seperti infarksi miokardium akut (AMI), dan kes kematian berkaitan trauma menggunakan ujian troponin I jantung berkepekaan tinggi (hs-cTnI). Kajian keratan rentas retrospektif ini meneliti kematian medikolegal semula jadi dan tidak semula jadi dari Julai 2022 hingga Disember 2023. Laporan autopsi dikaji untuk mengumpul maklumat demografi, penemuan autopsi dan tahap troponin jantung. Tahap troponin jantung dianalisis menggunakan ujian hs-cTnI. Sebanyak 219 kes telah dianalisis, mendedahkan bahawa tahap median hs-cTnI lebih tinggi dalam kes kematian jantung (5914.80 pg/ml) berbanding kematian bukan jantung (1246.10 pg/ml). Perbezaan yang signifikan diperhatikan antara tahap median troponin jantung dalam kematian akibat AMI (12145.25 pg/ml) dan punca kematian yang lain. Analisis ciri operasi penerima menunjukkan kawasan di bawah lengkung sebanyak 0.723 untuk hs-cTnI dalam kematian akibat AMI. Selain itu, pelbagai jenis kematian berkaitan trauma juga menunjukkan perbezaan yang ketara dalam tahap troponin. Sebanyak 219 kes telah dianalisis, yang terdiri daripada 84 kematian jantung dan 135 kematian bukan jantung, termasuk 59 kes kematian berkaitan trauma. Tahap median hs-cTnI adalah lebih tinggi dengan ketara dalam kes kematian jantung (5914.80 pg/ml) berbanding kematian bukan jantung (1246.10 pg/ml) (p < 0.01). Perbezaan yang signifikan diperhatikan antara tahap median troponin jantung dalam kematian akibat AMI (12145.25 pg/ml) dan punca kematian lain. Analisis ciri operasi penerima menunjukkan kawasan di bawah lengkung sebanyak 0.723 untuk hs-cTnI dalam kematian akibat AMI. Selain itu, pelbagai jenis kematian berkaitan trauma menunjukkan perbezaan yang ketara dalam tahap troponin. Walau bagaimanapun, kekurangan nilai rujukan yang ditetapkan memerlukan makmal individu untuk menetapkan penanda aras sendiri bagi menyokong pakar patologi forensik dalam ujian diagnostik pelengkap untuk kes postmortem. Kesimpulannya, hs-CTnl menawarkan ujian postmortem yang boleh dipercayai untuk membantu dalam mendiagnosis AMI.
Kata Kunci :
Biokimia postmortem; penyakit kardiovaskular; perubatan forensik; trauma; troponin I jantung kepekaan tinggi,
Correspondance Address
Dr Wan Mohammad Hafiz bin Wan Razali. Department of Forensic Pathology, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia. Tel: +6016-9866537 Email: drhafizrazali@gmail.com
