Histochemical Triphenyltetrazoium Chloride Staining Versus Ordinary Hematoxylin and Eosin Staining in the Detection of Acute Myocardial Infarction in Sudden Death Victims

Abstract

Background: Determining the cause of death in cases of sudden death continues to be a difficult task in forensic practice, with myocardial infarction being the leading cause of death. Given that significant visible changes typically take 24-48 hours to occur on the autopsy table. There is a necessity for a dependable and trustworthy test to identify early myocardial infarction MI, One potential test that shows promise is the triphenyltetrazoium chloride TTC stain. Aims and Objectives: To determine the diagnostic validity of the histochemical staining TTC of the heart in the gross detection of early MI. Materials and Methods: The current investigation was conducted in the Medico-Legal Directorate of Baghdad, Baghdad, Iraq. over a span of 3 months, commencing from November 1, 2022 and concluding on February 1, 2023. A total of forty individuals who experienced sudden deaths were selected at random. All of these individuals exhibited signs and symptoms of an unexpected illness before their deaths, which were suspected to be of cardiac origin. Results: The male population comprises the predominant demographic in the study, accounting for approximately 92.5%, whereas females constitute 7.5%. Sixteen samples from each of the study groups exhibited minimal or no staining with TTC, indicating a positive diagnosis for recent myocardial infarction. Out of the total sixteen samples positive for TTC. Histopathological examination confirmed that fourteen samples were true positives, while two samples were identified as false positives for TTC. The positive predictive value (P value) and sensitivity of the test are 93.10% and the negative predictive value (P value) and specificity of the test are 81.81%. The probability of a positive TTC test result is 6.75, while the probability of a negative TTC test result is 2.25. The overall validity of the test is 90%. Conclusion: The TTC staining technique demonstrated a 90% validity in the study, establishing it as a dependable and esteemed test in routine forensic practice.

Keywords

• autopsy
• myocardial infarction
• sudden death
• triphenyltetrazolium chloride stain