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Cazzato F, Grassi S, Brugada R, Oliva A. Letter to the editor regarding the article "Heart weight must not be measured before dissection during autopsies". Int J Legal Med 2024; 138:1663-1665. [PMID: 38374289 DOI: 10.1007/s00414-024-03189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Francesca Cazzato
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Salt, 17190, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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Yang T, Kong J, Shao X, Meng Z, Liang P, Zhou N, Jing J, Zhang F, Cheng M, Liu Z, Xu X, Li Y, Guo Y, Wang T, Chen J, Sun X, Zhang Z, Zhang F, Jin B, Wang W, Huang M, Zhang K, Wang H, Li D. A statistical study of postmortem heart weight in Chinese adults. Forensic Sci Int 2024; 354:111912. [PMID: 38103455 DOI: 10.1016/j.forsciint.2023.111912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Objective assessment of cardiac hypertrophy in forensic pathology practice is of great significance for forensic pathologists, for whom reference values for normal heart weights are needed. Developed regions such as Europe, the United States, and Japan recalculate the weight of human organs at regular intervals, but in China, there has been no systematic calculation of the weights of human organs since 2006. AIMS To statistically analyse the heart weight of Chinese adults postmortem and obtain a reference range. MATERIALS AND METHODS 4170 adult autopsy reports were collected from 12 forensic departments in 10 provinces in China. The causes of death were classified by sex, and heart weight and the heart weight/body height ratio reference values were further calculated according to different body mass index and body heights. Finally, the cutoff value of cardiac hypertrophy in Chinese adults was calculated. RESULTS In the group of non-cardiovascular disease causes of death, the cardiac weight of the electric death group was higher, while the heart weight of the prolonged bed-rest group was significantly reduced. After the electric death and prolonged bed-rest groups were excluded, heart weight, the heart weight/body height ratio, and cutoff values for cardiac hypertrophy were further classified and analysed according to body mass index. The mean reference values for heart weight in men and women with normal weight status were 325.82 ± 41.60 g and 286.39 ± 44.84 g, and the heart weight/body height ratios were 1.95 ± 0.23 in men and 1.82 ± 0.27, respectively. The cutoff values for cardiac hypertrophy were 387.35 g for men and 346.80 g for women. CONCLUSION The heart weight reference values of both sexes in this study were significantly higher than those in 2006, which is considered related to the development of China's economy and the improvement of people's living standards. This study also suggests the need for a new round of statistical surveys and updated data on the weight of other organs.
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Affiliation(s)
- Tengfei Yang
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Jiangwei Kong
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Xilin Shao
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Zilin Meng
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Peiyu Liang
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Nian Zhou
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Jiayu Jing
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Fu Zhang
- Guangdong Public Security Department, Guangzhou, China
| | - Ming Cheng
- Guangdong Public Security Department, Guangzhou, China
| | - Zengjia Liu
- Institute of Forensic Medicine and Laboratory Medicine, Jining Medical University, Jining, China
| | - Xiang Xu
- School of Forensic Medicine, Wannan Medical College, Wuhu, China
| | - Yingmin Li
- Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Yadong Guo
- Department of Forensic Medicine,School of Basic Medicine, Central South University, Changsha, China
| | - Tao Wang
- Department of Forensic Medicine, School of Biology & Basic Medical Sciences of Suzhou Medical School, Soochow University, Soochow, China
| | - Jianhua Chen
- Department of Forensic Medicine, Hainan Medical University, Haikou, China
| | - Xupeng Sun
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Zhong Zhang
- Wenzhou Medical University Forensic Center, Wenzhou, China
| | - Feng Zhang
- Wenzhou Medical University Forensic Center, Wenzhou, China
| | - Bo Jin
- Department of Forensic Pathology, Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong, China
| | - Wei Wang
- Department of Forensic Pathology, Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong, China
| | - Mengxue Huang
- Department of Forensic Pathology, Sichuan Huada Judicial Expertise Institute, Chengdu, China
| | - Kui Zhang
- Department of Forensic Pathology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Huijun Wang
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Dongri Li
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China; Guangdong Province Research Center of Traffic Accident Identification Engineering Technology, Guangzhou, China; Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou, China.
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Beer T, Eriksson A, Wingren CJ. Cardiac Enlargement in a Medicolegal Autopsy Setting. Am J Forensic Med Pathol 2023; 44:267-272. [PMID: 37819124 DOI: 10.1097/paf.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
ABSTRACT A key element for diagnosing cardiac enlargement in an autopsy setting is relevant heart weight references. However, most available references are to a large extent not representative of a medicolegal autopsy population, implying that reference weights are likely lower than those in the relevant population.To establish more applicable heart weight references in a medicolegal autopsy population, we designed a heart weight model that accounts for undiagnosed cardiac enlargement using data from 11,897 nontraumatic Swedish medicolegal autopsy cases autopsied between 2010 and 2019. The model was validated in 296 nonobese young adult suicidal hanging cases.For a decedent of average height (174 cm), the evidence that a heart weight was enlarged reached weak support at approximately 430 g, substantial support at approximately 480 g, and strong support at 520 g. The modeled prevalence of cardiac enlargement was very high among elderly and obese decedents.We believe that our model is more applicable in a medicolegal setting than those previously published. The presented quantification of the degree of uncertainty regarding diagnosis can help the pathologist in diagnosing cardiac enlargement. To facilitate the use of this model, we also made it available through a simple online tool ( https://formedum.shinyapps.io/HeartWeightCalc/ ).
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Affiliation(s)
- Torfinn Beer
- From the Department of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå
| | - Anders Eriksson
- From the Department of Community Medicine and Rehabilitation/Forensic Medicine, Umeå University, Umeå
| | - Carl Johan Wingren
- Forensic Medicine Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Westaby J, Dalle-Carbonare C, Ster IC, Sheppard MN. Obesity Cardiomyopathy in Sudden Cardiac Death: A Distinct Entity? A Comparative Study. JACC. ADVANCES 2023; 2:100414. [PMID: 38938994 PMCID: PMC11198605 DOI: 10.1016/j.jacadv.2023.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 06/29/2024]
Abstract
Background Obesity cardiomyopathy (OCM) can be associated with sudden cardiac death (SCD) but its pathologic features are not well described. Objectives The objective of this study was to characterize the clinical and pathological features of OCM associated with SCD. Methods This was a retrospective case control autopsy study. OCM was identified by an increased heart weight (>550 g in males; >450 g in females) in individuals with obesity (body mass index [BMI] ≥30 kg/m2) in the absence of other causes. Cases of OCM with SCD were compared to sex and age matched SCD controls with obesity or with normal weight (BMI 18.5-24.9 kg/m2) and morphologically normal hearts. Autopsy measures included: heart weight, atrial dimensions, ventricular wall thickness, and epicardial adipose tissue. Fibrosis was assessed microscopically. Results Of 6,457 SCD cases, 53 cases of OCM were identified and matched to 106 controls with obesity and 106 normal weight controls. The OCM mean age at death of individuals with OCM was 42 ± 12 with a male predominance (n = 34, 64%). Males died younger than females (40 ± 13 vs 45 ± 10, P = 0.036). BMI was increased in OCM cases compared to controls with obesity (42 ± 8 vs 35 ± 5). The average heart weight was 598 ± 93 g in OCM. There were increases in right and left ventricular wall thickness (all P < 0.05) in OCM cases compared to controls. Right ventricular epicardial fat was increased in OCM compared to normal weight controls only. Left ventricular fibrosis was identified in 7 (13%) cases. Conclusions OCM may be a specific pathological entity associated with SCD. It is most commonly seen in young males with increased BMI.
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Affiliation(s)
- Joseph Westaby
- Cardiovascular Clinical Academic Group and Cardiology Research Section, CRY Centre for Cardiovascular Pathology, Molecular and Clinical Sciences Research Institute, St. George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chiara Dalle-Carbonare
- Cardiovascular Clinical Academic Group and Cardiology Research Section, CRY Centre for Cardiovascular Pathology, Molecular and Clinical Sciences Research Institute, St. George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Irina Chis Ster
- Infection and Immunity Research Institute, St George’s University of London, London, United Kingdom
| | - Mary N. Sheppard
- Cardiovascular Clinical Academic Group and Cardiology Research Section, CRY Centre for Cardiovascular Pathology, Molecular and Clinical Sciences Research Institute, St. George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Westaby JD, Zullo E, Bicalho LM, Anderson RH, Sheppard MN. Effect of sex, age and body measurements on heart weight, atrial, ventricular, valvular and sub-epicardial fat measurements of the normal heart. Cardiovasc Pathol 2023; 63:107508. [PMID: 36442703 DOI: 10.1016/j.carpath.2022.107508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS Descriptive morphological studies of the normal heart are lacking. Previous autopsy studies have focused mainly on heart weight. We characterize the normal heart by providing normal dimensions of the atria, ventricles, valves and sub-epicardial fat, comparing the findings in terms of sex, age and body measurements. METHODS From 3602 referrals to our cardiovascular pathology unit, pathological criteria used for the classification of a morphologically normal heart were a weight of below 500 grams in males, and below 400 grams in females. Diseased hearts were excluded on anatomical and histological evaluation. RESULTS We diagnosed 1062 morphologically normal hearts. Mean age at death was 34±12, with a male predominance (701, 66%). Age was similar in females and males (35±13 vs 34±12). Females had a significantly lower heart weight (285±55 vs 374±64). Sex was an independent predictor of most measurements. The atrial and ventricular cavities were significantly larger in males. All ventricular measurements of muscle thickness were larger in males. All valvular circumferences were larger in males. In contrast, sub-epicardial fat was significantly thicker in females in 6 of 7 regions. This is the first study to provide a calculator to give expected values according to sex, age, height and weight. CONCLUSIONS Major differences between the sexes exist in the morphologically normal heart. These variations should be considered when assessing cardiac structure in imaging for risk stratification and diagnosis in the cardiomyopathies, as well as in treatment outcomes.
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Affiliation(s)
- Joseph David Westaby
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom.
| | - Emelia Zullo
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom
| | - Luciana Morais Bicalho
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom
| | - Robert Henry Anderson
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom
| | - Mary Noelle Sheppard
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom
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Berton M, Bettonte S, Stader F, Battegay M, Marzolini C. Repository Describing the Anatomical, Physiological, and Biological Changes in an Obese Population to Inform Physiologically Based Pharmacokinetic Models. Clin Pharmacokinet 2022; 61:1251-1270. [PMID: 35699913 PMCID: PMC9439993 DOI: 10.1007/s40262-022-01132-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
Abstract
Background Obesity is associated with physiological changes that can affect drug pharmacokinetics. Obese individuals are underrepresented in clinical trials, leading to a lack of evidence-based dosing recommendations for many drugs. Physiologically based pharmacokinetic (PBPK) modelling can overcome this limitation but necessitates a detailed description of the population characteristics under investigation. Objective The purpose of this study was to develop and verify a repository of the current anatomical, physiological, and biological data of obese individuals, including population variability, to inform a PBPK framework. Methods A systematic literature search was performed to collate anatomical, physiological, and biological parameters for obese individuals. Multiple regression analyses were used to derive mathematical equations describing the continuous effect of body mass index (BMI) within the range 18.5–60 kg/m2 on system parameters. Results In total, 209 studies were included in the database. The literature reported mostly BMI-related changes in organ weight, whereas data on blood flow and biological parameters (i.e. enzyme abundance) were sparse, and hence physiologically plausible assumptions were made when needed. The developed obese population was implemented in Matlab® and the predicted system parameters obtained from 1000 virtual individuals were in agreement with observed data from an independent validation obese population. Our analysis indicates that a threefold increase in BMI, from 20 to 60 kg/m2, leads to an increase in cardiac output (50%), liver weight (100%), kidney weight (60%), both the kidney and liver absolute blood flows (50%), and in total adipose blood flow (160%). Conclusion The developed repository provides an updated description of a population with a BMI from 18.5 to 60 kg/m2 using continuous physiological changes and their variability for each system parameter. It is a tool that can be implemented in PBPK models to simulate drug pharmacokinetics in obese individuals.
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Affiliation(s)
- Mattia Berton
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Sara Bettonte
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Bech AB, Clausen T, Waal H, Delaveris GJM, Skeie I. Organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder: a nation-wide 2-year cross-sectional study. Addiction 2022; 117:977-985. [PMID: 34648218 DOI: 10.1111/add.15705] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
AIMS To document organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder and estimate the extent to which individual characteristics are associated with pulmonary, cardiovascular, hepatic or renal pathologies. DESIGN Two-year cross-sectional nation-wide study. SETTING Norway. PARTICIPANTS Among all 200 patients who died during opioid agonist treatment between 1 January 2014 and 31 December 2015, 125 patients (63%) were autopsied. Among these, 122 patients (75% men) had available autopsy reports and were included. The mean age at the time of death was 48 years. MEASUREMENTS Information on pulmonary, cardiovascular, hepatic and renal pathologies were retrieved from forensic or medical autopsy reports, with no (0) and yes (1) as outcome variables and age, sex and body mass index as covariates in logistic regression analyses. FINDINGS Pathologies in several organs were common. Two-thirds (65%) of the decedents had more than two organ system diseases. The most common organ pathologies were chronic liver disease (84%), cardiovascular disease (68%) and pulmonary emphysema (41%). In bivariate analyses, only older age was associated with any pulmonary pathology [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.01-1.10], cardiovascular pathology (OR = 1.11; 95% CI = 1.05-1.17) and renal pathology (OR = 1.05; 95% CI = 1.00-1.11). Older age remained independently associated with cardiovascular pathology (OR = 1.10; 95% CI = 1.04-1.16) and renal pathology (OR = 1.06; 95% CI = 1.01-1.12) adjusted for body mass index and sex. CONCLUSIONS Among autopsied Norwegians who died during opioid agonist treatment in 2014 and 2015, two-thirds had more than two organ system diseases, despite their mean age of 48 years at the time of death. Older age was independently associated with at least one cardiovascular or renal pathology after adjusting for sex and body mass index.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
- National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | | | - Ivar Skeie
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
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Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Basso C, Michaud K, d'Amati G, Banner J, Lucena J, Cunningham K, Leone O, Vink A, van der Wal AC, Sheppard MN. Cardiac hypertrophy at autopsy. Virchows Arch 2021; 479:79-94. [PMID: 33740097 PMCID: PMC8298245 DOI: 10.1007/s00428-021-03038-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 12/31/2022]
Abstract
Since cardiac hypertrophy may be considered a cause of death at autopsy, its assessment requires a uniform approach. Common terminology and methodology to measure the heart weight, size, and thickness as well as a systematic use of cut off values for normality by age, gender, and body weight and height are needed. For these reasons, recommendations have been written on behalf of the Association for European Cardiovascular Pathology. The diagnostic work up implies the search for pressure and volume overload conditions, compensatory hypertrophy, storage and infiltrative disorders, and cardiomyopathies. Although some gross morphologic features can point to a specific diagnosis, systematic histologic analysis, followed by possible immunostaining and transmission electron microscopy, is essential for a final diagnosis. If the autopsy is carried out in a general or forensic pathology service without expertise in cardiovascular pathology, the entire heart (or pictures) together with mapped histologic slides should be sent for a second opinion to a pathologist with such an expertise. Indication for postmortem genetic testing should be integrated into the multidisciplinary management of sudden cardiac death.
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Affiliation(s)
- Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joaquin Lucena
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Seville, Spain
| | - Kristopher Cunningham
- Department of Laboratory Medicine and Pathobiology, Ontario Forensic Pathology Service, University of Toronto, Toronto, Canada
| | - Ornella Leone
- Cardiovascular and Cardiac Transplant Pathology Unit, Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Aryan Vink
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Mary N Sheppard
- Department of Cardiovascular Pathology, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's Medical School, London, UK
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Wach A, Faßbender C, Ackermann H, Parzeller M. [A retrospective mortality analysis of natural deaths of the 65+ generation based on postmortem autopsies performed at the Institute of Legal Medicine in Frankfurt am Main during two periods]. Rechtsmedizin (Berl) 2021; 31:509-519. [PMID: 33716407 PMCID: PMC7938877 DOI: 10.1007/s00194-021-00469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY In Germany, a constant demographic change is taking place, which leads to an increasing aging of the society. The present study aimed to analyze natural deaths occurring at an age of ≥ 65 years, since health vulnerability in this age group is gaining importance. MATERIAL AND METHODS Autopsy reports of the Institute of Forensic Medicine, University Hospital of the Goethe University Frankfurt/Main, Germany, were retrospectively evaluated regarding natural death cases of ≥ 65-year-olds in a time comparison (period I: 2000-2002; period II: 2013-2015). RESULTS During both periods, a total of 1206 autopsies concerning this age group were performed. Among these, 404 cases (33.5%) of unnatural death and 39 cases (3.2%) of a combination of natural and unnatural death were recorded; in 94 cases (7.8%), the manner of death could not be elucidated. The majority (n = 669; 55.5%) included cases of natural death. In the largest group of these (n = 350; 52.3%), cardiac causes of death were predominant, followed by 132 (19.7%) respiratory and 47 (7.0%) abdominal causes of death. In addition, 37 (5.5%) cases of malignant neoplasms, 33 (4.9%) of ruptures of large vessels, 33 (4.9%) of cerebral, and 37 (5.5%) other cases of natural death were noted. A significant decrease of cardiac causes of death was observed in the comparison of periods I and II. In particular, there was a significant decrease in high-grade occlusive coronary sclerosis. Moreover, there were significant differences between both sexes. Men had significantly more bypasses, stents and heart scars and suffered a myocardial infarction about 10 years earlier than women. CONCLUSION The results of the present study are largely consistent with the literature. The decrease in numbers of cardiac deaths may be attributed to increasingly better medical care and to a significantly higher rate of stent implantation. Especially in times of pandemics, the role of forensic gerontology will become more important.
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Affiliation(s)
- A. Wach
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
| | - C. Faßbender
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
| | - H. Ackermann
- Institut für Biostatistik und Mathematische Modellierung, Zentrum der Gesundheitswissenschaften, Klinikum und Fachbereich Medizin, Goethe-Universität Frankfurt a.M., Frankfurt am Main, Deutschland
| | - M. Parzeller
- Institut für Rechtsmedizin, Universitätsklinikum, Goethe-Universität Frankfurt a.M., Kennedyallee 104, 60596 Frankfurt am Main, Deutschland
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Kakimoto Y, Asakura K, Osawa M. Cutoff value for hypertrophic heart weight in the Japanese population. Leg Med (Tokyo) 2020; 48:101831. [PMID: 33370634 DOI: 10.1016/j.legalmed.2020.101831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiac hypertrophy is a clinical risk factor for cardiovascular death (CVD) frequently recorded in autopsy reports, but the diagnostic criteria for the condition have not been clearly-established for autopsy. This study aimed to estimate the cutoff value for hypertrophic heart weight that can efficiently assist the postmortem diagnosis of CVD. METHODS We analyzed accumulated autopsy data from 3534 individuals aged 0-101 years. RESULTS We found that heart weight increased linearly with a person's age until 20 years, after which it remained stable. The mean heart weight in CVD cases was 473 g in men and 379 g in women. The mean heart weight in non-CVD cases was 385 g in men and 320 g in women. Receiver operating characteristic curve analysis for CVD assessment revealed that the cutoff value of heart weight was 407 g (odds ratio of 4.2) in men and 327 g (2.6) in women, and that of heart weight/body height was 2.38 g/cm (4.0) in men and 2.15 g/cm (2.6) in women, respectively. Overall, heart weight was a more useful predictor of CVD in men than in women. In logistic regression analysis, the predictive power of heart weight for CVD was higher than that of body mass index in both sexes. CONCLUSION Thus, the criteria for hypertrophic heart weight are practical and useful for autopsy recordings, and it can be helpful for postmortem diagnosis of CVD. Our report is the first to reveal the cutoff value for hypertrophic heart weight in the Japanese population.
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Affiliation(s)
- Yu Kakimoto
- Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan.
| | | | - Motoki Osawa
- Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan
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Schoppen ZJ, Balmert LC, White S, Olson R, Arunkumar P, Dellefave‐Castillo LM, Puckelwartz MJ, George AL, McNally EM, Webster G. Prevalence of Abnormal Heart Weight After Sudden Death in People Younger than 40 Years of Age. J Am Heart Assoc 2020; 9:e015699. [PMID: 32885733 PMCID: PMC7726998 DOI: 10.1161/jaha.120.015699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background After sudden cardiac death in people aged <40 years, heart weight is a surrogate for cardiomegaly and a marker for cardiomyopathy. However, thresholds for cardiomegaly based on heart weight have not been validated in a cohort of cases of sudden cardiac death in young people. Methods and Results We surveyed medical examiner offices to determine which tools were used to assess heart weight norms. The survey determined that there was no gold standard for cardiomegaly (52 centers reported 22 different methods). We used a collection of heart weight data from sudden deaths in the Northwestern Sudden Death Collaboration (NSDC) to test the 22 methods. We found that the methods reported in our survey had little consistency: they classified between 18% and 81% of NSDC hearts with cardiomegaly. Therefore, we obtained biometric and postmortem data from a reference population of 3398 decedents aged <40 years. The reference population was ethnically diverse and had no known cardiac pathology on autopsy or histology. We derived and validated a multivariable regression model to predict normal heart weights and a threshold for cardiomegaly (upper 95% CI limit) in the young reference population (the Chicago model). Using the new model, the prevalence of cardiomegaly in hearts from the NSDC was 19%. Conclusions Medical examiner offices use a variety of tools to classify cardiomegaly. These approaches produce inconsistent results, and many overinterpret cardiomegaly. We recommend the model proposed to classify postmortem cardiomegaly in cases of sudden cardiac death in young people.
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Affiliation(s)
- Zachary J. Schoppen
- Division of CardiologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIL
| | - Lauren C. Balmert
- Department of Preventive Medicine (Biostatistics)Northwestern University Feinberg School of MedicineChicagoIL
| | | | - Rachael Olson
- Division of CardiologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIL
| | | | - Lisa M. Dellefave‐Castillo
- Center for Genetic Medicine and Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Megan J. Puckelwartz
- Department of PharmacologyNorthwestern University Feinberg School of MedicineChicagoIL
- Center for Genetic Medicine and Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Alfred L. George
- Department of PharmacologyNorthwestern University Feinberg School of MedicineChicagoIL
| | - Elizabeth M. McNally
- Center for Genetic Medicine and Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Gregory Webster
- Division of CardiologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIL
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Aktuelle Normwerte der Organgewichte und -indizes für die rechtsmedizinische Praxis, Teil 1. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-019-00370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nordrum IS, Skurdal AC. Studies on postmortem heart weight and missing citation - a response to Dr. Wingren. Cardiovasc Pathol 2016; 25:525. [PMID: 27816318 DOI: 10.1016/j.carpath.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ivar Skjåk Nordrum
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology and Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Norway
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Wingren CJ. Addressing the interplay between observed and modelled data in a "A retrospective study of postmortem heart weight in an adult Norwegian population". Cardiovasc Pathol 2016; 25:521. [PMID: 27736651 DOI: 10.1016/j.carpath.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Carl Johan Wingren
- Department of Forensic Medicine in Lund, the Swedish National Board of Forensic Medicine; Unit for Forensic Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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