Interest of TTC for the Early Diagnosis of Acute Myocardial Infarction at Autopsy

Study Overview
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Brief Summary
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Ischemic heart disease is the leading cause of death worldwide and the leading cause of sudden cardiac death. However, its post-mortem diagnosis is particularly difficult because the gross examination of the heart is usually normal at the autopsy . The diagnosis is therefore often based on a set of indirect arguments, such as the patient's medical and clinical history and the degree of occlusion of the coronary arteries. The formal diagnosis of acute myocardial infarction (AMI) currently relies on standard histological examination. However, histological findings often require a prolonged survival time of several hours to be highlighted. Triphenyltetrazolium chloride (TTC) is a salt that reacts with lactate dehydrogenases contained in still viable myocardial cells, forming a red pigment visible to the naked eye, (1,3,5 triphenylformazan). Ischemia-induced cell death, which occurs within minutes of the causative event, is responsible for the leakage of lactate deshydrogenase into the extracellular medium and thus results in the absence of formazan formation in the infarcted area, which displays an easily identifiable pale unstained color. It has been suggested that the use of TTC would allow the identification of MI as early as one hour of survival in animal models, before the usual macroscopic and microscopic signs are visible. It could therefore represent an attractive forensic tool for the early diagnosis of AMI at the autopsy.

Official Title
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Interest of Triphenyl Tetrazolium Chloride (TTC) for the Early Diagnosis of Acute Myocardial Infarction at Autopsy

Conditions
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Myocardial Infarction

Intervention / Treatment
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* Procedure: TTC immersion


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Adult patients autopsied at the Forensic Institute of the CHU of MONTPELLIER whose ante-mortem (medical history, cardiovascular risk factors, clinical history) and autopsy data (significant coronary stenosis associated or not with an endoluminal thrombus, scars of old infarction, absence of other identified cause of death) suggest AMI as the cause of death. Known survival time and postmortem interval. Exclusion criteria: - Putrefied bodies

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with AMI<br>Patients with AMI | Procedure: TTC immersion<br>* TTC immersion<br>|
| Patients with no AMI<br>Patients with no AMI | Procedure: TTC immersion<br>* TTC immersion<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Negative colorimetric reaction to TTC of infarcted myocardial tissue | Negative colorimetric reaction to TTC of infarcted myocardial tissue | day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival time (time from initial symptoms to death) | Survival time (time from initial symptoms to death) | day 1 | 
| Post-mortem interval (time from death to autopsy) | Post-mortem interval (time from death to autopsy) | day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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TTC, Sudden death, Early Acute Myocardial Infarction, Early markers, biochemicla markers