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Combined determination of B-type natriuretic peptide and high-sensitivity troponin I in the postmortem diagnosis of cardiac disease

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Abstract

Cardiac disease is the most common cause of sudden death in Western countries. It is known that high-sensitivity troponin I (hs-cTnI), widely used for detection of myocardial injury, is a sensitive biochemical marker. B-type natriuretic peptide (BNP) is a reliable tool for diagnosing heart failure, and for establishing prognosis or disease severity. We aimed to evaluate the diagnostic efficacy of the postmortem determination of BNP in serum alone or in addition to other biomarkers, such as hs-cTnI and MB isoenzyme of creatine kinase (CK-MB), to ascertain whether its determination improves the post-mortem diagnosis of heart failure-associated causes of death. This study involved 133 cadavers with a mean age of 58.2 (± 17.6) years and a mean postmortem interval of 12.8 (±6.6) h. Cases were assigned into two diagnostic groups, according to the cause of death: cardiac deaths (N = 62) and control (N = 71). In the cardiac group, two categories were established according to morphological features of the heart: ‘ischemic deaths’ (N = 39), and ‘congestive heart’ (n = 23). Both hs-cTnI and BNP were useful in diagnosing cardiac deaths, whereas CK-MB did not have any diagnostic relevance. hs-cTnI is higher in cases which acute ischemia as the principal pathology, while the presence of high BNP values is significantly related with chronic cardiac situations with significant ventricular overload. Our findings show that postmortem determination of hs-cTnI and BNP provides valuable information; hs-cTnI is useful for diagnosis of cardiac deaths, mainly with ischemic implications, and BNP gave better results for the diagnosis of congestive heart failure.

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References

  1. Campuzano O, Allegue C, Partemi S, Iglesias A, Oliva A, Brugada R. Negative autopsy and sudden cardiac death. Int J Legal Med. 2004;128:599–606.

    Article  Google Scholar 

  2. Belsey SL, Flanagan RJ. Postmortem biochemistry: Current applications. J Forensic Legal Med. 2016;41:49–57.

    Article  CAS  Google Scholar 

  3. Luna A, Carmona A, Villanueva E. The post-mortem determination of CK isozymes in the pericardial fluid in several causes of death. Forensic Sci Int. 1983;22:23–30.

    Article  CAS  Google Scholar 

  4. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Bessho Y, 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. Legal Med (Tokyo). 2007;9:241–50.

    Article  CAS  Google Scholar 

  5. Ooi DS, Isotalo PA, Veinot JP. Correlation of antemortem serum creatine kinase, creatine kinase-MB, troponin I, and troponin T with cardiac pathology. Clin Chem. 2000;46:338–44.

    CAS  PubMed  Google Scholar 

  6. Davies SJ, Gaze DC, Collinson PO. Investigation of cardiac troponins in postmortem subjects: comparing antemortem and postmortem levels. Am J Forensic Med Pathol. 2005;26:213–5.

    Article  Google Scholar 

  7. Martínez Díaz F, Rodríguez-Morlensín M, Pérez-Cárceles MD, Noguera J, Luna A, Osuna E. Biochemical analysis and immunohistochemical determination of cardiac troponin for the postmortem diagnosis of myocardial damage. Histol Histopathol. 2005;20:475–81.

    PubMed  Google Scholar 

  8. Khalifa AB, Najjar M, Addad F, Turki E, Mghirbi T. Cardiac troponin T (cTn T) and the postmortem diagnosis of sudden death. Am J Forensic Med Pathol. 2006;27:175–7.

    Article  Google Scholar 

  9. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Kamikodai Y, et 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;8:94–101.

    Article  CAS  Google Scholar 

  10. Gassenmaier T, Buchner S, Birner C, Jungbauer CG, Resch M, Debl K, et al. High-sensitive troponin I in acute cardiac conditions: implications of baseline and sequential measurements for diagnosis of myocardial infarction. Atherosclerosis. 2012;222:116–22.

    Article  CAS  Google Scholar 

  11. Zeller T, Ojeda F, Brunner FJ, Zeller T, Ojeda F, Brunner FJ, et al. High-sensitivity cardiac troponin I in the general population - defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study. Clin Chem Lab Med. 2015;53:699–706.

    Article  CAS  Google Scholar 

  12. Goetze JP. Biochemistry of pro-B-type natriuretic peptide-derived peptides: the endocrine heart revisited. Clin Chem. 2004;50:1503–10.

    Article  CAS  Google Scholar 

  13. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. J Card Fail. 2017;23:628–51.

    Article  Google Scholar 

  14. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Rev Esp Cardiol. 2016;69:1167.

    Article  Google Scholar 

  15. Madamanchi C, Alhosaini H, Sumida A, Runge MS. Obesity and natriuretic peptides, BNP and NT-proBNP: mechanisms and diagnostic implications for heart failure. Int J Cardiol. 2014;176:611–7.

    Article  Google Scholar 

  16. Melzi d'Eril G, Tagnochetti T, Nauti A, et al. Biological variation of N-terminal pro-brain natriuretic peptide in healthy individuals. Clin Chem. 2003;49:1554–5.

    Article  CAS  Google Scholar 

  17. Sabatasso S, Vaucher P, Augsburger M, Donzé N, Mangin P, Michaud K. Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination. Int J Legal Med. 2011;125:849–56.

    Article  Google Scholar 

  18. Michaud K, Augsburger M, Donzé N, Sabatasso S, Faouzi M, Bollmann M, et al. Evaluation of postmortem measurement of NT-proBNP as a marker for cardiac function. Int J Legal Med. 2008;122:415–20.

    Article  Google Scholar 

  19. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Tanaka S, et al. Postmortem pericardial natriuretic peptides as markers of cardiac function in medico-legal autopsies. Int J Legal Med. 2007;121:28–35.

    Article  Google Scholar 

  20. Chen JH, Michiue T, Ishikawa T, Maeda H. Molecular pathology of natriuretic peptides in the myocardium with special regard to fatal intoxication, hypothermia, and hyperthermia. Int J Legal Med. 2012;126:747–56.

    Article  Google Scholar 

  21. Woydt L, Bernhard M, Kirsten H, Burkhardt R, Hammer N, Gries A et al. Intra-individual alterations of serum markers routinely used in forensic pathology depending on increasing post-mortem interval Sci Rep 2018;8:12811.

  22. Basso C, Aguilera B, Banner J, et al. Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology. Virchows Arch. 2017;471:691–705.

    Article  Google Scholar 

  23. Pencina MJ, D’Agostino RB, D’Agostino RB Jr, Vasan RS. Evaluating the added predicitive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157–72.

    Article  Google Scholar 

  24. Maeda H, Zhu BL, Ishikawa T, Quan L, Michiue T. Significance of postmortem biochemistry in determining the cause of death. Leg Med (Tokyo). 2009;11:S46–9.

    Article  Google Scholar 

  25. Madea B, Musshoff F. Postmortem biochemistry. Forensic Sci Int. 2007;165:165–71.

    Article  CAS  Google Scholar 

  26. Polkin RT, Warner A, Troeaugh O. Evaluation of noninvasive tests of cardiac damage in suspected cardiac contusions. Circulation. 66:627–31.

  27. Siegel AJ, Silverman LM, Evans WJ. Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners. JAMA. 1983;250:2835–7.

    Article  CAS  Google Scholar 

  28. Wukich DK, Callaghan JJ, Graeber GM, Martyak T, Lyon JJ. Operative treatment of acute hip fractures: its effect on serum creatine kinase, lactate dehydrogenase and their isoenzymes. J Trauma. 1989;29:375–9.

    Article  CAS  Google Scholar 

  29. Apple FS, Murakami MM. Cardiac troponin and creatine kinase MB monitoring during in hospital myocardial reinfarction. Clin Chem. 2005;51:460–3.

    Article  CAS  Google Scholar 

  30. Jaffe AS, Ravkilde J, Roberts R, Naslund U, Apple FS, Galvani M, et al. It’s time for a change to a troponin standard. Circulation. 2000;102:1216–20.

    Article  CAS  Google Scholar 

  31. Hamm CW. Acute coronary syndromes. The diagnostic role of troponins. Thromb Res. 2001;103:S63–9.

    Article  CAS  Google Scholar 

  32. Moreno V, Hernández-Romero D, Vilchez JA, García-Honrubia A, Cambronero F, Casas T, et al. Serum levels of high-sensitivity troponin T: a novel marker for cardiac remodeling in hypertrophic cardiomyopathy. J Card Fail. 2010;16:950–6.

    Article  CAS  Google Scholar 

  33. Hernández-Romero D, Vílchez JA, Lahoz A, Romero-Aniorte AI, Orenes-Piñero E, Caballero L, et al. High-sensitivity troponin T as a biomarker for the development of atrial fibrillation after cardiac surgery. Eur J Cardiothorac Surg. 2014;45:733–8.

    Article  Google Scholar 

  34. Osuna E, Perez-Carceles MD, Alvarez MV, Noguera J, Luna A. Cardiac troponin I (cTn I) and the postmortem diagnosis of myocardial infarction. Int J Legal Med. 1998;111:173–6.

    Article  CAS  Google Scholar 

  35. Pérez-Cárceles MD, Noguera J, Jiménez JL, Martínez P, Luna A, Osuna E. Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease. Forensic Sci Int. 2004;142:1–7.

    Article  Google Scholar 

  36. Sapouna R, Gourgiotis D, Athanaselis S, Papadodima S, Spiliopoulou C. Diagnostic value of cardiac troponin I in postmortem diagnosis of myocardial infarction. Am J Forensic Med Pathol. 2013;34:139–41.

    Article  Google Scholar 

  37. Cao ZP, Xue JJ, Zhang Y, Tian MH, Xiao Y, Jia YQ, et al. Differential expression of B-type natriuretic peptide between left and right ventricles, with particular regard to sudden cardiac death. Mol Med Rep. 2017;16:4763–9.

    Article  CAS  Google Scholar 

  38. Mueller T, Gegenhuber A, Poelz W, Haltmayer M. Head-to-head comparison of the diagnostic utility of BNP and NT-proBNP in symptomatic and asymptomatic structural heart disease. Clin Chim Acta. 2004;341:41–8.

    Article  CAS  Google Scholar 

  39. Puelacher C, Wagener M, Honegger U, Assadian M, Schaerli N, Mueller D, et al. Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia. Clin Biochem. 2018;52:33–40.

    Article  CAS  Google Scholar 

  40. Bañón R, Navarro E, Noguera J, Benali L, Osuna E. Utilidad de la determinación de troponina T, CK-MB, NT-proBNP y mioglobina en humor vítreo en autopsias forenses. Rev Esp Med Legal. 2008;34:18–24.

    Google Scholar 

  41. Luna A. Is postmortem biochemistry really useful? Why is it not widely used in forensic pathology? Legal Med. 2009;11:S27–30.

    Article  Google Scholar 

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Funding

The authors do not declare external funding for the study.

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Authors and Affiliations

  1. Institute of Legal Medicine, Murcia, Spain

    Rafael Bañón

  2. Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB-Arrixaca), Regional Campus of International Excellence ‘‘Campus Mare Nostrum”, University of Murcia, Murcia, Spain

    Diana Hernández-Romero, María Dolores Pérez-Cárceles & Eduardo Osuna

  3. Institute of Legal Medicine, Alicante, Spain

    Esperanza Navarro

  4. Department of Biochemistry, University Hospital “Virgen de la Arrixaca”, Murcia, Spain

    José Antonio Noguera-Velasco

Authors
  1. Rafael Bañón
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  2. Diana Hernández-Romero
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  3. Esperanza Navarro
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  4. María Dolores Pérez-Cárceles
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Correspondence to Diana Hernández-Romero.

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The study was approved by the Ethics Committee of the Institute of Forensic Medicine and the Ethics Committee of the University of Murcia.

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Bañón, R., Hernández-Romero, D., Navarro, E. et al. Combined determination of B-type natriuretic peptide and high-sensitivity troponin I in the postmortem diagnosis of cardiac disease. Forensic Sci Med Pathol 15, 528–535 (2019). https://doi.org/10.1007/s12024-019-00150-1

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