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Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings

2001; Oxford University Press; Volume: 50; Issue: 2 Linguagem: Inglês

10.1016/s0008-6363(01)00261-9

1755-3245

Cristina Basso, Fiorella Calabrese, Domenico Corrado, Gaetano Thiene,

Cardiac electrophysiology and arrhythmias

Time for primary review 29 days. When sudden death (SD) occurs in adults and elderly persons, coronary atherosclerosis is the usual cause [1,2]. On the contrary, a large spectrum of cardiovascular diseases, both congenital and acquired, may account for SD in the young [3–10]. These diseases are frequently concealed and discovered with surprise only at postmortem by means of a thorough macroscopic and microscopic investigation. This review will address the spectrum of structural substrates of cardiac SD with particular emphasis given to the possible role of molecular biology techniques in identifying subtle or even merely functional disorders accounting for electrical instability. SD is defined as a natural, unexpected fatal event occurring within 1 h of the beginning of symptoms, in an apparently healthy subject or one whose disease was not so severe enough as to predict such an abrupt outcome [11]. In the USA, the annual incidence of SD in people aged 35–74 years is 191/100 000 in men and 57/100 000 in women; almost half of all SDs occur in people with known coronary artery disease [12]. In the Veneto region, Northeast of Italy, we recently calculated an overall prevalence of SD of 0.8/100 000/year in the young, based only upon autopsy reports [13]. When focusing the attention only on young athletes the prevalence was twice that in young non athletes, i.e. 1.6/100 000/year; these figures are explained by the existence of cardiovascular diseases which cause a risk of SD during effort, such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and congenital coronary anomalies. As far as pathophysiology is concerned, cardiac arrest may be either mechanical, when the heart and circulatory functions are suddenly impeded by mechanical factors (i.e. cardiac tamponade, pulmonary thromboembolism, etc.) or arrhythmic (mostly ventricular fibrillation) [9]. Based … * Corresponding author. Tel.: +39-49-827-2283; fax: +39-49-827-2284 cardpath{at}ux1.unipd.it