Unveiling the cause of sudden cardiac death: a macroscopic and microscopic analysis at the Institute of Forensic Medicine, Cluj-Napoca (Romania)
Authors:   Department of Forensic Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Forensic Medicine, Institute of Forensic Medicine, Cluj-Napoca, Romania, Pavel Daniela Cristina , Siserman Costel Vasile ,   Department of Forensic Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Forensic Medicine, Institute of Forensic Medicine, Cluj-Napoca, Romania, Vică Mihaela Laura ,   Department of Forensic Medicine, Institute of Forensic Medicine, Cluj-Napoca, Romania; Department of Cell and Molecular Biology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, Gheban Bogdan-Alexandru ,   Department of Histology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Pathology, Emergency County Clinical Hospital, Cluj-Napoca, Romania, Gheban-Roşca Ioana-Andreea ,   Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Epidemiology, Clinical Hospital for Infectious Diseases, Cluj-Napoca, Romania, Şonfălean Alexandra Maria ,   Department of Forensic Medicine, Institute of Forensic Medicine, Cluj-Napoca, Romania, Jurje Denisa Ştefania ,   Department of Forensic Medicine, Institute of Forensic Medicine, Cluj-Napoca, Romania, Lucian Denisa ,   Department of Forensic Medicine, Institute of Forensic Medicine, Cluj-Napoca, Romania, Bâlici Silvia Ştefana ,   Department of Cell and Molecular Biology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Published: February 2025

Sudden cardiac death (SCD) remains a critical public health problem, prompting efforts to understand its underlying causes and identify patients at risk. Despite declining cardiovascular mortality in developed nations, SCD still claims millions of lives annually, disproportionately affecting men and older individuals with a higher prevalence of ischemic heart disease. This study aimed to investigate the potential association between macroscopic and microscopic diagnoses in SCD cases based on a cohort of 3438 medico-legal autopsy reports collected at the Institute of Forensic Medicine, Cluj-Napoca, Romania, between 2014–2018. By analyzing representative heart tissue samples collected during autopsies, particularly from areas exhibiting visible abnormalities, we aimed to establish a link between macroscopic observations and microscopic confirmation. A detailed histopathological analysis on archived tissue samples focused on both ventricles, on areas with potential macroscopic indicators like myocardial ischemia, coronary atherosclerosis, and interstitial fibrosis. Standard techniques were employed to prepare tissue sections for microscopic examination, allowing for the evaluation of various parameters such as the presence and extent of atherosclerosis, necrosis, fibrosis, lipomatosis, edema, and blood stasis. This study investigated the correlation between macroscopic observations of potential SCD risk factors, such as ischemia, atherosclerosis, and fibrosis, and their microscopic confirmation through detailed tissue analysis. Our analysis revealed that circulatory-metabolic lesions of the heart, lung and brain are central and strongly correlated both macroscopically and microscopically with a SCD event, while non-circulatory pathology needs to pass the threshold for macroscopic diagnostics before being able to significantly influence the chances for developing a SCD event. Establishing such associations could improve the accuracy of high-risk SCD factors identification, potentially leading to more effective preventive strategies.