Autopsy examination in sudden cardiac death: a current perspective on behalf of the Association for European Cardiovascu
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ORIGINAL ARTICLE
Autopsy examination in sudden cardiac death: a current perspective on behalf of the Association for European Cardiovascular Pathology Jytte Banner 1 & Cristina Basso 2 & Zoe Tolkien 3 & Ivana Kholova 4 & Katarzyna Michaud 5 & Patrick J Gallagher 6 Received: 15 June 2020 / Revised: 22 September 2020 / Accepted: 11 October 2020 # The Author(s) 2020
Abstract In sudden cardiac death, an autopsy is an essential step in establishing a diagnosis of inherited cardiac disease and identifying families that require cardiac screening. To evaluate aspects of post-mortem practice in Europe, a questionnaire was designed and circulated to both clinical and forensic pathologists. There was a 48% response rate and information was obtained from 17 countries. The results showed a wide variety in the management of sudden cardiac death, with a general tendency towards a lack of thorough investigation. In up to 40% of cases, autopsies were not performed in subjects less than 50 years who may have died from cardiac disease. Reasons for this were lack of finance and lack of interest from police, legal authorities, and doctors. Only 50% of pathologists seem to follow a standard protocol for autopsy examination, apparently due to lack of expertise and/or training. When autopsies were performed, histology and toxicology were almost always taken, genetic studies were generally available and retention of the heart for specialist study was usually permitted. Our results suggest that although the standard of practice is appropriate in many centres, many more cases should have autopsies, especially in sudden deaths in subjects less than 50 years. Keywords Autopsy . Sudden cardiac death . Inherited cardiac conditions—cardiomyopathy
Introduction Sudden unexpected death is a frequent complication of many forms of cardiac disease. Because there is no internationally agreed definition of sudden cardiac death, the exact incidence is uncertain [1]. Nevertheless, a task force of the European Society of Cardiology has suggested that the incidence ranges from 36 to 128 deaths per 100,000 population per year [2]. Other This article is part of the Topical Collection on Quality in Pathology * Patrick J Gallagher [email protected] 1
Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
2
Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
3
NutriDART, Bristol, UK
4
Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
5
Centre Universitaire Romand de Médecine Légale, Lausanne, Genève, Switzerland
6
Medical Education, Bristol Medical School, Bristol, UK
reviews indicate that the incidence is between 50 and 100 per 100,000 population in a range of different countries [3, 4]. Ischaemic heart disease and heart failure are the most common causes [5, 6], but there are many other cardiac disorders associated with sudden death [7]. Some of these have a defined genetic basis and are thus inheritable [8]. This is e
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