Usefulness of Immunohistochemistry in Various Types of Sudden Cardiac Death.

Korean J Leg Med. 2005 May;29(1):21-32. Korean.

Department of Forensic Medicine, Kyungpook National University School of Medicine, Daegu, Korea. sanghan1@mail.knu.ac.kr

Postmortem diagnosis of early myocardial infarction is still a puzzling problem in forensic pathology practice, especially in sudden cardiac death. This study was undertaken to evaluate the distribution patterns of several immunohistochemical markers in various types of sudden cardiac death; 27 cases of obstructive coronary atherosclerosis (SCD-CAD) including 13 cases of critical coronary atherosclerosis, 6 cases of atherosclerotic heart disease and 8 cases of acute myocardial infarction, 26 cases of sudden cardiac death with obvious other causes (SCD-miscellaneous) including hypertensive heart disease, arrhythmogenic right ventricular cardiomyopathy, etc. and 14 cases of sudden cardiac death without any myocardial changes and/or minimal coronary atherosclerosis(SCDunknown). 10 cases of unnatural death were included in control group. Imnunohistochemical reactivity and the severity of reactivity loss were evaluated. The immunoreactivity against myoglobin and troponin C were excellent, and their reactivity loss were statistically significant in SCD-CAD compared to control group, SCD-unknown and SCD-miscellaneous (p<0.05). There were increasing pattern of loss of immunoreactivity in SCD-unknown and SCD-miscellaneous compared to control group. The pattern of expression and the severity of reactivity loss against vascular endothelial growth factor(VEGF) and basic fibroblast growth factor (bFGF) were with no differences in experimental group and control group. Immunohistochemistry may be partially useful in determination of early myocyte necrosis in sudden cardiac death, and myoglobin and troponin C may be better. But, its practical application in forensic pathology may be still limited.

Key Words : Immunohistochemistry, Sudden cardiac death, Myoglobin, Troponin C, Forensic pathology