RAPID CARDIO TROPONIN-T ASSAY IN PERICARDIAL FLUID FOR POST MORTEM DIAGNOSIS OF SUDDEN MYOCARDIAL INJURY: A CASE CONTROL STUDY
Keywords:
Cardiotroponin T, Sudden Myocardial Injury, Pericardial Fluid, Postmortem, Case Control study.Abstract
Background: Troponin T, a myofibrillary protein, is a constituent of the contractile apparatus of skeletal and cardiac muscle. Cardiac Troponin T (cTnT) concentration is raised in cases of myocardial injury. Rapid cTnT is routinely used in clinical settings to assess myocardial injury. Limited available literature on postmortem assessment of cTnT in pericardial fluid and blood suggest that its levels are raised in cases of sudden cardiac deaths (SCD) and electrocution. Keeping in view of the above a validation case control study was designed and executed with primary objective to ascertain cases of myocardial injury (SCD and electrocution [Test group]by a rapid cTnT in pericardial fluid on medico-legal postmortem examination and compare them with other non-cardiac causes of death [Control group]. Result: Rapid cTnT test from pericardial fluid was found positive in 35 (87.5%) cases in Test group and 32 (91.4%) cases in Control group. On comparison of the two groups by Chi-Square test it was found insignificant (P value=0.716).
References
1. DiMaio V, DiMaio D. Forensic Pathology. 2nd Ed. New York: CRC Boca Raton; 2001; p-43.
2. WHO Technical Report Series. Geneva: World Health Organization; 1975 [cited 2012 Sep 13].available from h t t p : / / w w w . w h q l i b d o c . w h o . i n t / t r s / WHO_TRS_562pdf.
3. Reddy KSN. The Essential of Forensic Medicine and Toxicology. 30th Ed. Hyderabad: K. Sugna Devi; 2012; p-136.
4. Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden death. Heart Rhythm. 2006; 3:108–13.
5. Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out-of-hospital ventricular fibrillation, 1980–2000. JAMA. 2002; 288: 3008–3013.
6. Myerburg RJ, Interian A, Simmons J, Castellanos A. Sudden cardiac death. In: Zipes DP, ed. Cardiac Electrophysiology: From Cell to Bedside. 4th ed. Philadelphia: WB Saunders; 2004:720–731.
7. Woo KS, Tse KK, Mak YK, Chung HK. The impact of thrombolytic therapy on hospital mortality from acute myocardial infarction in the Chinese in Hong Kong.
Intern J Cardiol 1992; 37:169-75.
8. Woo KS, White HD. Pharmacoeconomic aspects of treatment of acute myocardial infarction with thrombolytic agents. Pharmacoeconomics 1993; 3:192- 204.
9. Tunstall-Pedoe H, KuulasmaaK, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Circulation 1994; 90:583-612.
10. Kannel WB. Prevalence and clinical aspects of unrecognized myocardial infarction and sudden unexpected death. Circulation 1987; 75(suppl. II); I14- II5.
11. Grimm RH, Tillinghast S, Daniels K, Neaton JD et al. Unrecognized myocardial infarction: experience in the multiple risk factor intervention trial (MRFIT). Circulation 1987; 75 (suppl. II); II6-II8.
12. White T, Woodmansey P, Ferguson DG, Channer KS. Improving the interpretation of electrocardiograms in an accident and emergency department. Postgrad Med J 1995; 71:132-5.
13. Westdrop EJ, Gratton MC, Watson WA. Emergency department interpretation of electrocardiograms. Ann Emerg Med 1992; 21:541-4.
14. Ptileo PR, et al. Early diagnosis of acute myocardial infarction based on assay for sub forms of CKMB. Circulation 1990, 82:759-764.
15. Dhoot GK, Gell PG, Perry SV. The localization of the different forms of troponin I in skeletal and cardiac muscle cells. Exp Cell Res 1978;117:357-70.
16. Dhoot GK, Perry SV. Distribution of polymorphic forms of troponin components and tropomyosin in skeletal muscle. Nature 1979;278:714-8.
17. Schreier T, Kedes L, Gahlmann R. Cloning, structural analysis, and expression of the human slow twitch skeletal muscle/cardiac troponin C gene. J Biol Chem 1990;265:21247-53.
18. Cummins P, Perry SV. Troponin I from human skeletal and cardiac muscles. Biochem J 1978;171:251-9.
19. Vallins WJ, Brand NJ, Dabhade N, et al. Molecular cloning of human cardiac troponin I using polymerase chain reaction. FEBS Lett 1990;270:57-61.
20. Perry SV. Troponin I: inhibitor or facilitator. Mol Cell Biochem 1999;190:9-32.
21. Katrukha A. Antibody selection strategies in cardiac troponin assay. In: Wu AHB, editor. Cardiac markers. 2nd ed. Totowa (NJ): Humana Press Inc., 2003. p. 173- 85.
22. Larue C, Defacque-Lacquement H, Calzolari C, et al. New monoclonal antibodies as probes for human cardiac troponin I: epitopic analysis with synthetic
peptides. Mol Immunol 1992;29: 271-8.
23. Perry SV. Troponin T: genetics, properties and function. J Muscle Res Cell Motil 1998;19:575-602.
24. Gahlmann R, Troutt AB, Wade RP, et al. Alternative splicing generates variants in important functional domains of human slow skeletal troponin T. J Biol Chem 1987; 262:16122-6.
25. Saggin L, Gorza L, Ausoni S, et al. Troponin I switching in the developing heart. J Biol Chem 1989; 264:16299-302.
26. Cina SJ, Brown DK, Smailek JE, Collins KA. A Rapid Postmortem Cardiac Troponin T Assay and Laboratory Evidence of Sudden Cardiac Death. Am J Forensic Med Pathol 2001; 22:173-6.
27. Roche Cardiac Troponin T sensitive, Leaflet. Ref. no.11621947196.
28. Zhu BL, Ishikawa T, Michiue T, Li DR,Zhao D, Kamikodai Yet al. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2: analysis for application in the diagnosis of sudden cardiac death with regard to pathology. Leg Med (Tokyo). 2006 Mar; 8(2):94-101.
29. Ellingsen CL, Hetland O. Serum Concentrations of Cardiac Troponin T in Sudden Death. Am J Forensic Med Pathol 2004; 25:213-5.
30. Pérez-Carceles MD, Noguera J, Jiménez JL, MartínezP,Luna A, Osuna E. Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischemic heart disease. Forensic Sci Int. 2004 May 28; 142(1):1-7.
31. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Oritani S. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1. Analysis with special regard to traumatic causes of death. Leg Med (Tokyo). 2006 Mar; 8(2):86-93.
32. Remmer S, Kuudeberg A, Tõnisson M, Lepik D, Väli M. Cardiac troponin T in forensic autopsy cases. Forensic Sci Int. 2013 Dec 10; 233(1-3):154-7.
33. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Oritani S, et al. Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy. Leg Med (Tokyo). 2007 Sep; 9(5):241-50
34. Stewart RV, Zumwalt RE, Hirsch CS, Kaplan L. Postmortem diagnosis of myocardial disease by enzyme analysis of pericardial fluid. Am J Clin Pathol. 1984 Oct; 82(4):411-7.