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2018 ; 62
(2
): 2866
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Diagnosis of sudden cardiac death due to early myocardial ischemia: An
ultrastructural and immunohistochemical study
#MMPMID29943950
Visonā SD
; Benati D
; Monti MC
; Galič M
; Andrello L
; Frontini A
; Osculati A
Eur J Histochem
2018[Apr]; 62
(2
): 2866
PMID29943950
show ga
The aim of this post-mortem ultrastructural and immunohistochemical study is to
explore the characteristics of acute myocardial ischemia in the context of sudden
death, using the combination of two different methods, both more insightful than
ordinary histology. Transmission electron microscope and immunohistochemistry, in
addition to the traditional histology, were applied to study human heart
specimens collected during forensic autopsies. The whole series was sub-grouped
into cases (n=17) and controls (n=10). The control group consisted of unnatural
death with a short agonal period (immediately lethal injuries). Heart samples of
the two cohorts of subjects were prepared for electron microscopy. On the other
hand, each specimen, formalin fixed and paraffin embedded, was stained with
haematoxylin and eosin and immunoreacted with the following primary antibodies:
antiFibronectin, antiConnexin-43, anti npCx43 (dephosphorylated form of
Connexin43), antiZonula occludens-1. Immunopositivity of each marker in the
myocardium was semi-quantitatively graded. Electron microscopy revealed a number
of interesting differences between acute myocardial ischemia and controls,
regarding the morphology of nucleus, mitochondria and intercellular junctions. By
immunohistochemistry, fibronectin was found to be markedly increased in the
extracellular matrix of the acute myocardial ischemia cases, with a remarkable
difference in respect of controls. Connexin 43 staining disclosed a slightly
increase in the cytoplasm of acute myocardial ischemia cases with respect to the
controls, whereas no relevant differences were seen between cases and controls at
intercellular junctions. Dephosphorylated form of Cx43 showed an evident
difference of staining in cases compared to controls and overall this difference
more evident in the cytoplasm. Zonula occludens 1, described as an important
marker for functional modification of cardiac muscle fibers, resulted negative or
very weak in the vast majority of both cases and controls. The present study
attempts to simultaneously apply electron microscopy and immunohistochemistry, in
order to figure out the morphological changes that might lead to pathological
processes underlying the sudden, unexpected death due to acute myocardial
ischemia, and consequently to find useful diagnostic markers of very early
ischemic injury. Both methods showed significant differences between acute
myocardial ischemia and controls, regarding, overall nuclei, mitochondria, and
intercellular junctions.Â.