Incidence of Focal Myocarditis at Autopsy
S Papamitrou, N Cresswell, C Solomon, Y Zhang, D Fowler, F Tavora, M Franco, A Burke. Pace University, New York, NY; Armed Forces Institute of Pathology, Washington, DC; Office of the Armed Forces Medical Examiner, Rockville, MD; University of Maryland, Baltimore, MD; Federal University of Sao Paulo, Sao Paulo, Brazil
Background: The significance of focal cardiac inflammation in sudden death is often unclear. There are few studies addressing the incidence of presumed incidental focal infiltrates at autopsy.
Design: We prospectively assessed inflammation in 393 consecutive hearts seen in consultation from 2 medical examiners' offices. Hearts were received intact and sectioned uniformly in 5 areas (3 left ventricle, one ventricular septum, and one right ventricle) and reviewed histologically by a single pathologist. Inflammation was classified as focal, multifocal, inflammation with necrosis, and eosinophilic. Histologic findings were retrospectively correlated with other cardiac findings, history of drug and medication use, post-mortem toxicology, and cause of death in the final autopsy report. 9 cases with myocarditis as a primary cause of death were excluded. Of the 384 hearts, there were 239 cardiac non-inflammatory deaths. There were 51 natural non-cardiac deaths, and 94 unnatural deaths.
Results: In the 384 hearts, any infiltrates were found in 18%, multifocal infiltrates in 9%, inflammation with necrosis in 2%, and eosinophilic myocarditis in 4% of hearts. Incidental infiltrates were most frequent in natural non-cardiac deaths (31%), followed by drug-related deaths (20%), natural cardiac deaths (16%), and traumatic deaths (12%). Infiltrates with necrosis were present in 4% of arrhythmic deaths with no other cause, in 3% of cardiac deaths with cardiomegaly, in 2% of natural non-cardiac deaths, in 1 traumatic death (3%), in 1 coronary death (1%), and in 0 other cardiac or drug-related death. Any infiltrate was most frequently seen in patients on antibiotics (55%) or neuroleptic drugs (30%), and eosinophilic infiltrates presumed secondary to hypersensitivity were seen in 18% of patients on antibiotics and 5% of patients on other medications. Contraction band necrosis was most frequent in resuscitation or brain death > 3 hours (55%) and prolonged resuscitation < 3 hours (12%) vs. 2% of non-resuscitated deaths.
Conclusions: Incidental cardiac inflammatory infiltrates without necrosis are not uncommon, but focal myocarditis, as defined as inflammation with necrosis, occurs in <5% of hearts, and should be considered a possible contributory factor.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 28, Wednesday Afternoon