Aquaro Giovanni Donato, Guidi Benedetta, Biondi Federico, Chiti Enrica, Santurro Alessandro, Scopetti Matteo, Turillazzi Emanuela, Di Paolo Marco
Fondazione Toscana G. Monasterio, 56124 Pisa, Italy.
UO Medicina legale, University of Pisa, 56124 Pisa, Italy.
Diagnostics (Basel). 2020 Nov 21;10(11):981. doi: 10.3390/diagnostics10110981.
Post-mortem cardiac magnetic resonance (PMCMR) is an emerging tool supporting forensic medicine for the identification of the causes of cardiac death, such as hypertrophic cardiomyopathy (HCM). We proposed a new method of PMCMR to diagnose HCM despite myocardial rigor mortis.
We performed CMR in 49 HCM patients, 30 non-HCM hypertrophy, and 32 healthy controls. In cine images, rigor mortis was simulated by the analysis of the cardiac phase corresponding to 25% of diastole. Left ventricular mass, mean, and standard deviation (SD) of WT, maximal WT, minimal WT, and their difference were compared for the identification of HCM. These parameters were validated at PMCMR, evaluating eight hearts with HCM, 10 with coronary artery disease, and 10 with non-cardiac death.
The SD of WT with a cut-off of > 2.4 had the highest accuracy to identify HCM (AUC 0.95, 95% CI = 0.89-0.98). This was particularly evident in the female population of HCM (AUC=0.998), with 100% specificity (95% CI = 85-100%) and 96% sensitivity (95% CI = 79-99%). Using this parameter, at PMCMR, all of the eight patients with HCM were correctly identified with no false positives.
PMCMR allows identification of HCM as the cause of sudden death using the SD of WT > 2.4 as the diagnostic parameter.
尸检心脏磁共振成像（PMCMR）是一种新兴工具，可辅助法医学鉴定心脏死亡原因，如肥厚型心肌病（HCM）。我们提出了一种新的PMCMR方法，用于在存在心肌尸僵的情况下诊断HCM。
我们对49例HCM患者、30例非HCM肥厚患者和32例健康对照者进行了CMR检查。在电影图像中，通过分析对应于舒张期25%的心动周期来模拟尸僵。比较左心室质量、室壁厚度（WT）的平均值、标准差（SD）、最大WT、最小WT及其差值，以识别HCM。这些参数在PMCMR中进行了验证，评估了8例HCM心脏、10例冠状动脉疾病心脏和10例非心脏死亡心脏。
WT标准差>2.4作为截断值时，识别HCM的准确性最高（AUC 0.95，95%CI = 0.89 - 0.98）。这在HCM女性人群中尤为明显（AUC = 0.998），特异性为100%（95%CI = 85 - 100%），敏感性为96%（95%CI = 79 - 99%）。使用该参数，在PMCMR中，8例HCM患者全部被正确识别，无假阳性。
PMCMR可将WT标准差>2.4作为诊断参数，识别HCM为猝死原因。
