title: Right heart ischemia in cases of sepsis.
abstract: Data from the literature suggest that cases of sepsis complicated by right ventricular (RV) dysfunction have poorer prognosis. In these cases progressive hypoperfusion associated to increasing, injury-related, pulmonary vascular resistance account for RV ischemia. In the present analysis, we wanted to evaluate whether prevalent RV cardiac ischemic damage could be detected in a series of fatal sepsis cases. We retrospectively investigated 20 cases of sepsis that underwent forensic autopsy (study group-11♀, 9♂, mean age 57 years) and compared them to a group of 20 cases of hanging (hanging group-4 ♀, 16 ♂, mean age 44 years) as well as to a group of 20 cases of myocardial infarction (MI group-9 ♀, 11 ♂, mean age 65 years), as examples of cardiac damage due to global hypoxia during agony and ischemic damage, respectively. We performed immunohistochemistry with the antibodies anti-fibronectin and C5b-9. The reactions were semiquantitively classified and the groups were compared. In 30% of the cases of sepsis prevalent RV ischemic damage could be detected with the antibody anti-fibronectin. This expression was significantly different from that observed in cases of MI (p=0.028) and hanging (p<0.001). Our study showed that, in cases of fatal sepsis, prevalent RV ischemic damage occurred in a substantial minority of cases.
authors.affiliation: University Center of Legal Medicine, Lausanne-Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland. Electronic address: Tony.Fracasso@hcuge.ch.
authors.forename: T
authors.initials: T
authors.lastname: Fracasso
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstr. 23, 48149 Münster, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Jentgens
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstr. 23, 48149 Münster, Germany. Electronic address: Heidi.Pfeiffer@ukmuenster.de.
authors.forename: H
authors.initials: H
authors.lastname: Pfeiffer
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstr. 56, 48129 Münster, Germany. Electronic address: sauerla@uni-muenster.de.
authors.forename: C
authors.initials: C
authors.lastname: Sauerland
authors.affiliation: University Center of Legal Medicine, Lausanne-Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland. Electronic address: Patrice.Manging@hcuge.ch.
authors.forename: P
authors.initials: P
authors.lastname: Mangin
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstr. 23, 48149 Münster, Germany. Electronic address: Andreas.Schmeling@ukmuenster.de.
authors.forename: A
authors.initials: A
authors.lastname: Schmeling
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications*
keywords: Forensic pathology; Immunohistochemistry; Ischemia; Right ventricle; Sepsis