• post-mortem magnetic resonance
• autopsy
• sudden cardiac death

This research project has concerned the study of Sudden Cardiac Death (SCD), in order to deepen our comprehension of its pathogenic mechanisms and to find new tools for the recognition of the underlying cardiac alterations that are often not known before death.
Indeed, SCD represents a major public health issue and, in particular for young victims, it constitutes a dramatic event whose impact and public health burden are greater than those of any specific cancer, and of most other leading causes of death.
The diagnosis of fatal cardiac diseases, the management and ongoing care of families struck by juvenile SCD are among the most challenging scenarios in forensic and clinical medicine.
This research has been carried out through a cooperative working relationship with the cardio-radiologist dr. G.D. Aquaro of the Fondazione Toscana Gabriele Monasterio, who performed the post-mortem cardiac magnetic resonance.
All the sudden death, occurring in subjects aged from >15 to <80 years old, in the territories of the north-west coast of Tuscany (province of Pisa, Lucca and Livorno) from December 2013 to July 2019 were underwent to autopsy investigation to investigate the cause of death.
The autopsy was performed in 46 cases according to recommendation of the current guide lines for autopsy in SCD cases. Once excluded an extracardiac cause of SD the heart was explanted after the evaluation of pericardium and pulmonary veins anatomy. The heart was fixed in a formalin solution and then a PM-CMR of the explanted heart was performed. Gross examination and histological investigation of the heart was carried out after imaging.
We used 10 cases in which death occurred for extracardiac causes as control, to measure reference values of T1-, T2- and T2* mapping of myocardium fixed with formalin.
Findings of PM-CMR permitted to have the following suspicions: 19 ischemic heart disease; 5 Hypertrophic cardiomyopathy; 5 arrhythmogenic cardiomyopathy; 1 myocarditis; 1 septal neoformation; 1 traumatic heart rupture; in 5 patients PM-CMR was completely negative; 6 diffuse myocardial damage; finally non diagnostic images for possible bad fixation in 3.
At gross and histological examination a final diagnosis of ischemic heart disease was performed in 20 patients (41,5%); Hypertrophic cardiomyopathy was found in 5 cases (12%); a diffuse myocardial damage in the context of death for systemic disease in 5 patients (sepsis, pancreatitis, pneumonia in AIDS, acute drugs intoxication in 2); 1 septal neoformation (vascular malformation); 1 traumatic heart rupture; acute myocarditis in 1 patients; in 12 patients no signs of cardiac disease were found; 1 heart was in advanced decomposition not permitting histological analysis.
Overall there was a perfect matching between PM-CMR in 32 out of 46 patients (78%). Considering gross/histologic examination, PM-CMR demonstrated a sensitivity 93.3%, a specificity 63%, AUC 0.65 (0.48-0.79), PPV 80%, NPV 66.7%.