International Journal of Legal Medicine

, Volume 130, Issue 5, pp 1265–1280 | Cite as

Early markers for myocardial ischemia and sudden cardiac death

  • Sara Sabatasso
  • Patrice Mangin
  • Tony Fracasso
  • Milena Moretti
  • Mylène Docquier
  • Valentin Djonov
Original Article


The post-mortem diagnosis of acute myocardial ischemia remains a challenge for both clinical and forensic pathologists. We performed an experimental study (ligation of left anterior descending coronary artery in rats) in order to identify early markers of myocardial ischemia, to further apply to forensic and clinical pathology in cases of sudden cardiac death. Using immunohistochemistry, Western blots, and gene expression analyses, we investigated a number of markers, selected among those which are currently used in emergency departments to diagnose myocardial infarction and those which are under investigation in basic research and autopsy pathology studies on cardiovascular diseases. The study was performed on 44 adult male Lewis rats, assigned to three experimental groups: control, sham-operated, and operated. The durations of ischemia ranged between 5 min and 24 h. The investigated markers were troponins I and T, myoglobin, fibronectin, C5b-9, connexin 43 (dephosphorylated), JunB, cytochrome c, and TUNEL staining. The earliest expressions (≤30 min) were observed for connexin 43, JunB, and cytochrome c, followed by fibronectin (≤1 h), myoglobin (≤1 h), troponins I and T (≤1 h), TUNEL (≤1 h), and C5b-9 (≤2 h). By this investigation, we identified a panel of true early markers of myocardial ischemia and delineated their temporal evolution in expression by employing new technologies for gene expression analysis, in addition to traditional and routine methods (such as histology and immunohistochemistry). Moreover, for the first time in the autopsy pathology field, we identified, by immunohistochemistry, two very early markers of myocardial ischemia: dephosphorylated connexin 43 and JunB.


Early markers Myocardial ischemia Forensic pathology Clinical pathology Sudden cardiac death 



We are grateful to Prof Brenda Kwak, Dr Sandrine Morel, and Mrs Regula Buergy for their expertise, assistance, and performance of Western blots for Cx43.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

414_2016_1401_MOESM1_ESM.doc (30 kb)
ESM 1 (DOC 30 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sara Sabatasso
    • 1
    • 2
  • Patrice Mangin
    • 1
  • Tony Fracasso
    • 1
  • Milena Moretti
    • 1
    • 2
  • Mylène Docquier
    • 3
  • Valentin Djonov
    • 2
  1. 1.University Center of Legal Medicine Lausanne-GenevaGenevaSwitzerland
  2. 2.Institute of AnatomyUniversity of BernBernSwitzerland
  3. 3.Genomics platform, Centre Médical UniversitaireUniversity of GenevaGenevaSwitzerland

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