title: Cardiac biomarkers in blood, and pericardial and cerebrospinal fluids of forensic autopsy cases: A reassessment with special regard to postmortem interval.
abstract: 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) <12h. After 12h 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 <48h. 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.
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Uehonmachi 7-1-16-1308, Tennoji, Osaka 543-0001, Japan. Electronic address: m2049040@med.osaka-cu.ac.jp.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Uehonmachi 7-1-16-1308, Tennoji, Osaka 543-0001, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Inamori-Kawamoto
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Uehonmachi 7-1-16-1308, Tennoji, Osaka 543-0001, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Michiue
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Uehonmachi 7-1-16-1308, Tennoji, Osaka 543-0001, Japan.
authors.forename: Sayuko
authors.initials: S
authors.lastname: Ikeda
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Uehonmachi 7-1-16-1308, Tennoji, Osaka 543-0001, Japan; Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, Uehonmachi 7-1-16-1308, Tennoji, Osaka 543-0001, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maeda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001494:Baths; D015415:Biomarkers / Q000032:analysis* / Q000097:blood / Q000134:cerebrospinal fluid; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D052279:Creatine Kinase, MB Form / Q000032:analysis* / Q000097:blood / Q000134:cerebrospinal fluid; D004332:Drowning / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011180:Postmortem Changes; D020107:Troponin T / Q000032:analysis* / Q000097:blood / Q000134:cerebrospinal fluid; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form
keywords: Blood; Body fluid; Cardiac marker; Forensic biochemistry; Myocardial injury; Postmortem interval