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Correlations and discrepancies between cardiac ultrasound, clinical diagnosis and the autopsy findings in early deceased patients with suspected cardiovascular emergencies

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Abstract

Cardiac ultrasound (CUS), either focused cardiac ultrasound (FoCUS) or emergency echocardiography, is frequently used in cardiovascular (CV) emergencies. We assessed correlations and discrepancies between CUS, clinical diagnosis and the autopsy findings in early deceased patients with suspected CV emergencies. We retrospectively analysed clinical and autopsy data of 131 consecutive patients who died within 24 h of hospital admission. The type of CUS and its findings were analysed in relation to the clinical and autopsy diagnoses. CUS was performed in 58% of patients - FoCUS in 83%, emergency echocardiography in 12%, and both types of CUS in 5% of cases. CUS was performed more frequently in patients without a history of CV disease (64 vs. 40%, p = 0.08) and when the time between admission and death was longer (6 vs. 2 h, p = 0.021). In 7% of patients, CUS was inconclusive. In 10% of patients, the ante-mortem cause of death could not be determined, while discrepancies between the clinical and post-mortem diagnosis were found in 26% of cases. In the multivariate logistic regression model, only conclusive CUS [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.30–7.39, p = 0.044] and chest pain at presentation (OR 30.19, 95%CI 5.65 -161.22, p < 0.001) were independently associated with congruent clinical and autopsy diagnosis. In a tertiary university hospital, FoCUS was used more frequently than emergency echocardiography in critically ill patients with suspected cardiac emergencies. Chest pain at presentation and a conclusive CUS were associated with concordant clinical and autopsy diagnoses.

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The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

The authors would like to thank all medical professionals involved in the care of patients in the Emergency room and Coronary Care Unit of Clinical Hospital Centre Zemun, Belgrade, Serbia, as well as the forensic pathologists and technicians who performed the autopsies at the Institute of Forensic Medicine, Belgrade, Serbia.

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Authors and Affiliations

  1. Department of Cardiology, Clinical Hospital Centre Zemun, Vukova 9, Belgrade, 11080, Serbia

    Ivan Stankovic, Aleksandra Zivanic, Ivona Vranic & Aleksandar N. Neskovic

  2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Ivan Stankovic & Aleksandar N. Neskovic

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  1. Ivan Stankovic
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  2. Aleksandra Zivanic
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  3. Ivona Vranic
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  4. Aleksandar N. Neskovic
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All listed authors contributed to the manuscript, in the following manner: - conception and design or analysis and interpretation of data, or both (IS, AZ, IV, ANN) - drafting of the manuscript or revising it critically for important intellectual content (IS, AZ, IV, ANN)- final approval of the manuscript submitted (IS, AZ, IV, ANN).

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Correspondence to Ivan Stankovic.

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Stankovic, I., Zivanic, A., Vranic, I. et al. Correlations and discrepancies between cardiac ultrasound, clinical diagnosis and the autopsy findings in early deceased patients with suspected cardiovascular emergencies. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03107-w

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