title: Demographic, clinical and pathological features of sudden deaths due to myocarditis: Results from a state-wide population-based autopsy study.
abstract: Causes of sudden cardiac deaths have been widely reported with limited data focused specifically on myocarditis. A retrospective review of cases from the Office of the Chief Medical Examiner (OCME), State of Maryland yielded a total of 103 sudden unexpected deaths (SUDs) due to myocarditis (0.17% of all SUDs and 0.70% of autopsied SUDs) from 2005 through 2014. Most deaths occurred in patients <30 years of age with a male:female ratio 1.3:1. Of the 103 cases, 45 (43.7%) patients were witnessed collapsed. Four deaths occurred during exertion, such as exercising at the gym or performing heavy physical work, and 2 deaths were associated with emotional stress. The common cardiac macroscopic findings included ventricular dilatation (39.8%), mild coronary stenosis (17.5%), mottled myocardial appearance (15.5%), and myocardial fibrosis (10.7%). The histological classification of myocarditis was based on the predominant type of inflammatory cell infiltration. In our study group, lymphocytic myocarditis was most common, accounting for 56 cases (54.4%), followed by neutrophilic (32 cases, 31.7%), eosinophilic (13 cases, 12.6%) and giant cell type (2 cases, 1.9%). Microscopic examination revealed myocyte necrosis in 69 cases (67.0%) and interstitial or perivascular fibrosis in 48 cases (46.6%). The percentage of myocyte necrosis was 75.0% (42/58 cases) in lymphocytic, 65.6% (21/31 cases) in neutrophilic, 30.8% (4/13 cases) in eosinophilic, and 100% (2/2 cases) in giant cell myocarditis. Determination of myocarditis as cause of death continues to present a major challenge to forensic pathologists, because histopathologic findings can be subtle and the diagnosis of myocarditis remains difficult.
authors.affiliation: Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, PR China; Sino-US Forensic Science Research Center, Collaborative Innovation Center of Judicial Civilization, Office of the Chief Medical Examiner, Baltimore, MD 21223, USA.
authors.forename: Liliang
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, 21201, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, 21201, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Burke
authors.affiliation: Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, PR China.
authors.forename: Aimin
authors.initials: A
authors.lastname: Xue
authors.affiliation: Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, PR China.
authors.forename: Ziqin
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, PR China; Department of Pathology, University of Maryland School of Medicine, 21201, USA; Sino-US Forensic Science Research Center, Collaborative Innovation Center of Judicial Civilization, Office of the Chief Medical Examiner, Baltimore, MD 21223, USA.
authors.forename: David
authors.initials: D
authors.lastname: Fowler
authors.affiliation: Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, PR China. Electronic address: shenyiwen@fudan.edu.cn.
authors.forename: Yiwen
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, PR China; Department of Pathology, University of Maryland School of Medicine, 21201, USA; Sino-US Forensic Science Research Center, Collaborative Innovation Center of Judicial Civilization, Office of the Chief Medical Examiner, Baltimore, MD 21223, USA. Electronic address: lingl@ocmemd.org.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000473:pathology; D023921:Coronary Stenosis / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D004804:Eosinophils / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000473:pathology; D049429:Forensic Pathology; D015726:Giant Cells / Q000473:pathology; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009205:Myocarditis / Q000401:mortality* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D032383:Myocytes, Cardiac / Q000473:pathology; D009336:Necrosis; D009504:Neutrophils / Q000473:pathology; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult
keywords: Certainty of diagnosis; Dilated cardiomyopathy; Myocarditis; Sudden deaths