Comparison of ante- and postmortem ventricular wall thickness using echocardiography and autopsy findings

Abstract

In autopsy practice, the thickness of ventricular walls is one of the parameters used to identify cardiac hypertrophy. The presented study aimed to compare ante- and postmortem measurements of ventricular wall thickness, (i) to determine a postmortem standardized localization and dissection method for ventricular wall measurements, and (ii) to determine the ability of postmortem measurements in recognition of antemortem hypertrophy. A single-center prospective study was conducted at the Institute of Legal Medicine in Hamburg, Germany. Sixty hearts were dissected alternating by the inflow-outflow or short-axis method, and the ventricular walls were measured at different locations and compared with the echocardiographic values of the end-diastolic phase during life of these individuals. The results showed measurement differences between the autoptic and echocardiographic values-for the left ventricle between 3.3 and 5.2 mm, for the right ventricle between 0.2 and 1.1 mm, and for the septum between 1.3 and 1.4 mm. Diagnostic performance of recognizing antemortem hypertrophy with postmortem measurement was poor, except for measuring the right ventricle and septum with the short-axis method (area under the ROC curve of 0.72 and 0.82, respectively). According to the results, cardiac changes may occur postmortem and need to be considered when used for diagnosing cardiac pathology. The postmortem diagnosis of left or right ventricular hypertrophy should always be made in conjunction with other, particularly cardiac, autopsy findings. An autoptic diagnosis of hypertrophy solely by a ventricular wall thickness > 15 mm or > 5 mm alone is not sufficient.

Keywords: Cardiac dissection; Cardiac hypertrophy; Cardiac pathologies; Forensic autopsy; Ventricular wall thickness.

Fig. 1

Heart dissection according to the inflow-outflow method. The ventricular walls were measured 1 and 2 cm below the tricuspid valve (for the right ventricle), the aortic valve, and the mitral valve (for the left ventricle). The measurement taken below the aortic valve is illustrated here as an example (indicated white lines)

Fig. 2

Heart dissection according to the short-axis method. Both the left and right ventricular wall as well as the septum were measured at the level of the papillary muscles (middle ventricular level) on the opposite sides, excluding epicardial fatty tissue and the papillary muscle (black lines)

Fig. 3

a Bland–Altman plots illustrating the differences between the measurements against their mean values for the inflow-outflow method for all measured localizations. LVPW PLAX, left ventricular posterior wall thickness in parasternal long axis; LVPW SAX, left ventricular posterior wall thickness in short axis; RV subcostal, right ventricular wall thickness subcostal. b Bland–Altman plots illustrating the differences between the measurements against their mean values for the short-axis method are shown in the figure for all measured localizations. RV subcostal, right ventricular wall thickness subcostal; IVS PLAX, interventricular septum thickness in parasternal long axis; IVS SAX, interventricular septum thickness in short axis

Fig. 3

a Bland–Altman plots illustrating the differences between the measurements against their mean values for the inflow-outflow method for all measured localizations. LVPW PLAX, left ventricular posterior wall thickness in parasternal long axis; LVPW SAX, left ventricular posterior wall thickness in short axis; RV subcostal, right ventricular wall thickness subcostal. b Bland–Altman plots illustrating the differences between the measurements against their mean values for the short-axis method are shown in the figure for all measured localizations. RV subcostal, right ventricular wall thickness subcostal; IVS PLAX, interventricular septum thickness in parasternal long axis; IVS SAX, interventricular septum thickness in short axis