Sacco Matteo Antonio, Gualtieri Saverio, Grimaldi Gioele, Monterossi Maria Daniela, Aquila Valerio Riccardo, Tarallo Alessandro Pasquale, Verrina Maria Cristina, Ranno Francesco, Gratteri Santo, Aquila Isabella
Institute of Legal Medicine, Department of Medical and Surgical Sciences, "Magna Graecia" University, 88100 Catanzaro, Italy.
Int J Mol Sci. 2024 Dec 26;26(1):105. doi: 10.3390/ijms26010105.
Postmortem diagnosis of myocardial ischemia remains a challenge in forensic pathology, as traditional methods like autopsy and histology may not always provide conclusive results. Cardiac troponins, specifically cTnI and cTnT, are well-established biomarkers for myocardial injury in living patients, but their role in postmortem ischemia diagnosis is still under investigation. This systematic review aims to evaluate the role of troponins in diagnosing myocardial ischemia in postmortem cases, focusing on the diagnostic accuracy, sample types, and the influence of the postmortem interval (PMI). A systematic search on PubMed NCBI was conducted to identify studies published between 2000 and 2024 that evaluated the use of cTnI and cTnT in postmortem myocardial ischemia diagnosis. The studies were assessed for their sample types, methods of troponin quantification, sensitivity, specificity, and the impact of PMI on the stability of troponin levels. The review included 13 studies that utilized various sample types, including serum, femoral blood, and pericardial fluid. cTnT was found to be more reliable than cTnI, particularly in pericardial fluid, with shorter PMIs (typically under 48 h) showing higher sensitivity and specificity for myocardial ischemia. Pericardial fluid provided the most consistent results, followed by serum and femoral blood. Studies also highlighted that longer PMIs negatively affected the reliability of troponin measurements due to postmortem degradation. Cardiac troponins, especially cTnT, are valuable biomarkers for diagnosing myocardial ischemia postmortem, particularly when measured in pericardial fluid and within a short PMI. The use of multimarker strategies and the development of standardized cut-off values are needed to improve the accuracy of troponin measurements in forensic pathology. Future research should focus on standardizing diagnostic thresholds, improving assay sensitivity, and exploring new sample types and imaging techniques to enhance postmortem cardiovascular diagnostics.
在法医病理学中，心肌缺血的尸检诊断仍然是一项挑战，因为诸如尸检和组织学等传统方法可能并不总能提供确凿的结果。心肌肌钙蛋白，特别是肌钙蛋白I（cTnI）和肌钙蛋白T（cTnT），是活体患者心肌损伤的公认生物标志物，但其在尸检缺血诊断中的作用仍在研究中。本系统评价旨在评估肌钙蛋白在尸检病例中心肌缺血诊断中的作用，重点关注诊断准确性、样本类型以及死后间隔时间（PMI）的影响。在PubMed NCBI上进行了系统检索，以识别2000年至2024年期间发表的评估cTnI和cTnT在尸检心肌缺血诊断中应用的研究。对这些研究的样本类型、肌钙蛋白定量方法、敏感性、特异性以及PMI对肌钙蛋白水平稳定性的影响进行了评估。该评价纳入了13项研究，这些研究使用了各种样本类型，包括血清、股静脉血和心包液。发现cTnT比cTnI更可靠，特别是在心包液中，较短的PMI（通常在48小时以内）对心肌缺血显示出更高的敏感性和特异性。心包液提供的结果最一致，其次是血清和股静脉血。研究还强调，较长的PMI由于死后降解而对肌钙蛋白测量的可靠性产生负面影响。心肌肌钙蛋白，尤其是cTnT，是诊断死后心肌缺血的有价值的生物标志物，特别是在心包液中且PMI较短时进行测量。需要使用多标志物策略并制定标准化的临界值，以提高法医病理学中肌钙蛋白测量的准确性。未来的研究应侧重于标准化诊断阈值、提高检测敏感性，并探索新的样本类型和成像技术，以加强死后心血管诊断。
