Clinical and histopathological analysis of the prevalence of cardiac diseases in sudden death: a study based on autopsies

Análisis clínico e histopatológico de la prevalencia de enfermedades cardiacas en muerte súbita. Estudio en autopsias

Introduction: a sudden death incident has a great impact on society and its study is important to provide understanding for strengthening promotion and prevention strategies. Objective: to determine the prevalence of definitive anatomopathological cardiac diagnoses and histopathological findings associated with sudden death due to a cardiovascular cause based on autopsies performed at Hospital de San José in Bogotá DC, Colombia, during the period between 2015 and 2018. Methods: retrospective descriptive cross-sectional study of cases of sudden cardiac death of cardiovascular origin diagnosed in autopsies performed at the pathology service of Hospital de San José, Bogotá DC, Colombia. Results: 178 autopsies with a diagnosis of sudden cardiac death were included. The overall mean age was 56.1 years (SD: 15.06). Male/female ratio was 3:1. The most frequent macroscopic finding was cardiomegaly (average 428.1 g (SD 112.8), with the presence of sclerotic coronary artery disease (p=0.000) with a blockage greater than 80% (p=0.037) in the major coronary arteries. Conclusions: the prevalent definitive anatomopathological diagnoses in SCD were complicated chronic ischemic heart disease (65%) and acute myocardial infarction (16%). Data obtained in this study is similar to that reported worldwide. Cardiomegaly is a frequent finding that should be carefully evaluated.  

1. Boczek NJ, Tester DJ, Ackerman MJ. The molecular autopsy: an indispensable step following sudden cardiac death in the young?. Herzschrittmacherther Elektrophysiol. 2012;23(3):167-73. doi: 10.1007/s00399-012-0222-x
2. Tester DJ, Ackerman MJ. The molecular autopsy: should the evaluation continue after the funeral?. Pediatr Cardiol. 2012;33(3):461-70. doi: 10.1007/s00246-012-0160-8
3. Semsarian C, Ingles J, Wilde AA. Sudden cardiac death in the young: the molecular autopsy and a practical approach to surviving relatives. Eur Heart J. 2015;36(21):1290-6. doi: 10.1093/eurheartj/ehv063
4. Departamento Administrativo Nacional de Estadística. Estadisticas Vitales-EEVV. Cifras definitivas año 2018 (con corte final al 31 de Octubre del 2019) [Internet]. 2019 [Consultado marzo 2020]. Disponible en: https://www.dane.gov.co/files/investigaciones/poblacion/cifras-definitivas-2018.pdf
5. de Asmundis C, Brugada P. Epidemiología de la muerte súbita cardiaca. Rev Esp Cardiol Supl. 2013;13(A):2-6. doi: 10.1016/S1131-3587(13)70060-8
6. Giraldo CA, Mesa A, García S, Hurtado M. Muerte súbita. Estudio prospectivo en Medellín, Colombia, 1982. Bol Of Sanit Panam. 1984;96(6):532-50.
7. Mendoza O, Bonilla JC, Moreno L, Piedrahita C, Mosquera A, Parra-Medina R. Review of clinical non-medico-legal autopsy: a descriptive study in 747 patients. Egypt J Forensic Sci. 2018;8(1):66. https://doi.org/10.1186/s41935-018-0093-3
8. Daya M, Schmicker R, May S, Morrison L. Current burden of cardiac arrest in the United States: report from the Resuscitation Outcomes Consortium [Internet ]. 2015 [Consultado marzo 2020]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK321501/
9. Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan Jr PW, et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation. 2013;127(14):1538-63. doi: 10.1161/CIR.0b013e31828b2770
10. Olasveengen TM, de Caen AR, Mancini ME, Maconochie IK, Aickin R, Atkins DL, et al. 2017 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Circulation. 2017;136(23):e424-e40. doi: 10.1161/CIR.0000000000000541
11. Chan PS, McNally B, Tang F, Kellermann A. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation. 2014;130(21):1876-82. doi: 10.1161/CIRCULATIONAHA.114.009711
12. Bonilla JC, Parra-Medina R, Chaves JJ, Campuzano O, Sarquella-Brugada G, Brugada R, et al. La autopsia molecular en la muerte súbita cardiaca. Archivos de Cardiología de México. 2018;88(4):306-312. https://doi.org/10.1016/j.acmx.2018.06.001
13. Basso C, Aguilera B, Banner J, Cohle S, d’Amati G, de Gouveia RH, et al. Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology. Virchows Arch. 2017;471(6):691-705. doi: 10.1007/s00428-017-2221-0
14. Wong CX, Brown A, Lau DH, Chugh SS, Albert CM, Kalman JM, et al. Epidemiology of sudden cardiac death: global and regional perspectives. Heart Lung Circ. 2019;28(1):6-14. doi: 10.1016/j.hlc.2018.08.026
15. Garg S, Hasija S, Sharma P, Kalhan S, Saini N, Khan A. A histopathological analysis of prevalence of various heart diseases: an autopsy study. Int J Res Med Sci. 2018;6(4):1414. http://dx.doi.org/10.18203/2320-6012.ijrms20181306
16. Paratz ED, Rowsell L, Zentner D, Parsons S, Morgan N, Thompson T, et al. Cardiac arrest and sudden cardiac death registries: a systematic review of global coverage. Open Heart. 2020;7(1):e001195. doi: 10.1136/openhrt-2019-001195
17. Chugh SS, Jui J, Gunson K, Stecker EC, John BT, Thompson B, et al. Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large US community. J Am Coll Cardiol. 2004;44(6):1268-75. doi: 10.1016/j.jacc.2004.06.029
18. Rao BH, Sastry B, Chugh SS, Kalavakolanu S, Christopher J, Shangula D, et al. Contribution of sudden cardiac death to total mortality in India—a population based study. Indian heart J. 2012;154(2):163-7. doi: 10.1016/j.ijcard.2010.09.016
19. Tseng ZH, Olgin JE, Vittinghoff E, Ursell PC, Kim AS, Sporer K, et al. Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCD study. Circulation. 2018;137(25):2689-2700. doi: 10.1161/CIRCULATIONAHA.117.033427
20. de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, Van Ree JW, Daemen MJ, Houben LG, et al. Out-of-hospital cardiac arrest in the 1990s: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol. 1997;30(6):1500-5. doi: 10.1016/s0735-1097(97)00355-0
21. Tham YK, Bernardo BC, Ooi JY, Weeks KL, McMullen JR. Pathophysiology of cardiac hypertrophy and heart failure: signaling pathways and novel therapeutic targets. Arch Toxicol. 2015;89(9):1401-38. doi: 10.1007/s00204-015-1477-x
22. Cunningham KS, Spears DA, Care MJ. Evaluation of cardiac hypertrophy in the setting of sudden cardiac death. Forensic Sci Res. 2019;4(3):223-40. doi: 10.1080/20961790.2019.1633761
23. Joshi CJ. Postmortem study of histopathological lesions of heart in cases of sudden death-an incidental finding. J Evid Based Med Healthc. 2016;3(6):184-8.
24. Janicki JS, Brower GL, Levick SP. The emerging prominence of the cardiac mast cell as a potent mediator of adverse myocardial remodeling. Methods Mol Biol. 2015;1220:121-39. doi: 10.1007/978-1-4939-1568-2_8
25. Laine P, Kaartinen M, Penttilä A, Panula P, Paavonen T, Kovanen PT. Association between myocardial infarction and the mast cells in the adventitia of the infarct-related coronary artery. Circulation. 1999;99(3):361-9. doi: 10.1161/01.cir.99.3.361
26. Rios-Navarro C, Gavara J, Vidal V, Bonanad C, Racugno P, Bayes-Genis A, et al. Characterization and implications of the dynamics of eosinophils in blood and in the infarcted myocardium after coronary reperfusion. PLoS One. 2018;13(10):e0206344. doi: 10.1371/journal.pone.0206344
27. Güner A, Zehİr R, KalçIk M, Uslu A, Ösken A, Kalkan AK, et al. Eosinophil percentage as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Interventional Medicine and Applied Science. 201911(3):146-153. https://doi.org/10.1556/1646.11.2019.17
28. Thiblin I, Garmo H, Garle M, Holmberg L, Byberg L, Michaëlsson K, et al. Anabolic steroids and cardiovascular risk: a national population-based cohort study. Drug Alcohol Depend. 2015;152:87-92. doi: 10.1016/j.drugalcdep.2015.04.013
29. Vassalini M, Verzeletti A, Restori M, De Ferrari F. An autopsy study of sudden cardiac death in persons aged 1–40 years in Brescia (Italy). J Cardiovasc Med. 2016;17(6):446-53. doi: 10.2459/JCM.0000000000000234
30. Li L, Zhang Y, Burke A, Xue A, Zhao Z, Fowler D, et al. Demographic, clinical and pathological features of sudden deaths due to myocarditis: results from a state-wide population-based autopsy study. Forensic Sci Int. 2017;272:81-6. doi: 10.1016/j.forsciint.2016.12.037
31. Ripoll-Vera T, Pérez Luengo C, Borondo Alcázar JC, García Ruiz AB, Sánchez Del Valle N, Barceló Martín B, et al. Sudden cardiac death in persons aged 50 years or younger: diagnostic yield of a regional molecular autopsy program using massive sequencing. Rev Esp Cardiol (Engl Ed). 2020;74(5):402-413. doi: 10.1016/j.rec.2020.03.030