{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:06:04Z","timestamp":1777867564440,"version":"3.51.4"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001779","name":"Monash University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001779","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Forensic Sci Med Pathol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hemopericardium is regularly seen at autopsy and post-mortem imaging. Once traumatic cases and resuscitation artefact are excluded, hemopericardium is almost always due to either ruptured myocardial infarction or aortic dissection. In this study, we explored whether post-mortem cardiac-specific troponin I (cTnI) can be helpful when autopsy is not feasible and post-mortem imaging findings are inconclusive. Post-mortem cTnI levels were compared between 46 cases with hemopericardium due to ruptured myocardial infarction (RMI), 38 cases of hemopericardium due to aortic dissection (AoD), and 44 cases of natural deaths without hemopericardium (controls). The results showed significantly higher cTnI levels in the RMI group (median 5,821 ng\/L) compared to AoD (median 273 ng\/L) and controls (median 95 ng\/L). Receiver operating characteristic (ROC) analysis indicated that a cTnI threshold of 1,483 ng\/L provided the best balance of sensitivity (87%) and specificity (90%) for distinguishing RMI from AoD. Levels of cTnI above 9688 ng\/L were exclusively seen in RMI, whilst levels\u2009&lt;\u2009250 ng\/L excluded this diagnosis. Calculated likelihood ratios demonstrated that higher levels of cTnI favour RMI over AoD, but substantial overlap between the cohorts limited the diagnostic value of intermediate cTnI values. Autopsy remains the gold standard for determining the cause of hemopericardium and cTnI testing is best reserved for cases in which an autopsy is not feasible.<\/jats:p>","DOI":"10.1007\/s12024-025-01043-2","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T16:26:50Z","timestamp":1752164810000},"page":"239-244","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-mortem cardiac-specific troponin-I (cTnI) to determine the cause of non-traumatic hemopericardium"],"prefix":"10.1007","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8590-0945","authenticated-orcid":false,"given":"Hans H.","family":"de Boer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan D.","family":"Sutton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Pricone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1238-1360","authenticated-orcid":false,"given":"Sarah","family":"Parsons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"issue":"20","key":"1043_CR1","doi-asserted-by":"publisher","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","volume":"138","author":"K Thygesen","year":"2018","unstructured":"Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138(20):e618\u201351.","journal-title":"Circulation"},{"issue":"7","key":"1043_CR2","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1161\/CIRCULATIONAHA.122.059678","volume":"146","author":"Y Sandoval","year":"2022","unstructured":"Sandoval Y, Apple FS, Mahler SA, Body R, Collinson PO, Jaffe AS, et al. High-sensitivity cardiac troponin and the 2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guidelines for the evaluation and diagnosis of acute chest pain. Circulation. 2022;146(7):569\u201381.","journal-title":"Circulation"},{"issue":"1","key":"1043_CR3","first-page":"55","volume":"13","author":"RA Byrne","year":"2024","unstructured":"Byrne RA, Rossello X, Coughlan J, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European society of cardiology (ESC). Eur Heart Journal: Acute Cardiovasc Care. 2024;13(1):55\u2013161.","journal-title":"Eur Heart Journal: Acute Cardiovasc Care"},{"key":"1043_CR4","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.forsciint.2018.09.002","volume":"292","author":"C Barberi","year":"2018","unstructured":"Barberi C, van den Hondel KE. The use of cardiac troponin T (cTnT) in the postmortem diagnosis of acute myocardial infarction and sudden cardiac death: A systematic review. Forensic Sci Int. 2018;292:27\u201338.","journal-title":"Forensic Sci Int"},{"key":"1043_CR5","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.forsciint.2018.05.051","volume":"289","author":"T Beausire","year":"2018","unstructured":"Beausire T, Faouzi M, Palmiere C, Fracasso T, Michaud K. High-sensitive cardiac troponin hs-TnT levels in sudden deaths related to atherosclerotic coronary artery disease. Forensic Sci Int. 2018;289:238\u201343.","journal-title":"Forensic Sci Int"},{"key":"1043_CR6","doi-asserted-by":"publisher","first-page":"S266","DOI":"10.1016\/j.legalmed.2009.01.005","volume":"11","author":"H Maeda","year":"2009","unstructured":"Maeda H, Michiue T, Zhu B-L, Ishikawa T, Quan L. Analysis of cardiac troponins and creatine kinase MB in cerebrospinal fluid in medicolegal autopsy cases. Leg Med. 2009;11:S266\u20138.","journal-title":"Leg Med"},{"key":"1043_CR7","unstructured":"Mart\u00ednez D\u00edaz F, Rodr\u00edguez Morlens\u00edn M, P\u00e9rez C\u00e1rceles MD, Noguera J, Luna A, Osuna Carrillo-Albornoz EJ. Biochemical analysis and immunohistochemical determination of cardiac troponin for the postmortem diagnosis of myocardial damage. Histol Histopathol. 2005;20(2):475\u201381."},{"key":"1043_CR8","doi-asserted-by":"publisher","unstructured":"Sutton ED, Parsons S, Pricone M, de Boer HH. Cardiac-specific troponin (cTnI) in a post-mortem setting. Int J Legal Med. 2025. https:\/\/doi.org\/10.1007\/s00414-025-03526-x (e-pub ahead of print).","DOI":"10.1007\/s00414-025-03526-x"},{"key":"1043_CR9","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s00428-017-2221-0","volume":"471","author":"C Basso","year":"2017","unstructured":"Basso C, Aguilera B, Banner J, Cohle S, d\u2019Amati G, De Gouveia RH, et al. Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the association for European cardiovascular pathology. Virchows Arch. 2017;471:691\u2013705.","journal-title":"Virchows Arch"},{"issue":"2","key":"1043_CR10","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s00428-022-03458-6","volume":"482","author":"K Michaud","year":"2023","unstructured":"Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, et al. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases\u2013current achievements and limitations from a pathology perspective: endorsed by the association for European cardiovascular pathology and by the international society of forensic radiology and imaging. Virchows Arch. 2023;482(2):385\u2013406.","journal-title":"Virchows Arch"},{"issue":"6","key":"1043_CR11","first-page":"405","volume":"22","author":"S Shiotani","year":"2004","unstructured":"Shiotani S, Watanabe K, Kohno M, Ohashi N, Yamazaki K, Nakayama H. Postmortem computed tomographic (PMCT) findings of pericardial effusion due to acute aortic dissection. Radiat Med. 2004;22(6):405\u20137.","journal-title":"Radiat Med"},{"issue":"6","key":"1043_CR12","doi-asserted-by":"publisher","first-page":"W568","DOI":"10.2214\/AJR.15.14808","volume":"205","author":"R Yamaguchi","year":"2015","unstructured":"Yamaguchi R, Makino Y, Chiba F, Torimitsu S, Yajima D, Shinozaki T, et al. Fluid-fluid level and pericardial hyperdense ring appearance findings on unenhanced postmortem CT can differentiate between postmortem and antemortem pericardial hemorrhage. Am J Roentgenol. 2015;205(6):W568\u201377.","journal-title":"Am J Roentgenol"},{"issue":"5","key":"1043_CR13","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.legalmed.2014.05.005","volume":"16","author":"L Filograna","year":"2014","unstructured":"Filograna L, Thali MJ, Marchetti D. Forensic relevance of post-mortem CT imaging of the haemopericardium in determining the cause of death. Leg Med. 2014;16(5):247\u201351.","journal-title":"Leg Med"},{"key":"1043_CR14","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1007\/s12024-015-9654-z","volume":"11","author":"G Ampanozi","year":"2015","unstructured":"Ampanozi G, Flach PM, Fornaro J, Ross SG, Schweitzer W, Thali MJ, et al. Systematic analysis of the radiologic findings of aortic dissections on unenhanced postmortem computed tomography. Forensic Sci Med Pathol. 2015;11:162\u20137.","journal-title":"Forensic Sci Med Pathol"},{"key":"1043_CR15","doi-asserted-by":"crossref","unstructured":"Ampanozi G, Flach PM, Ruder TD, Filograna L, Schweitzer W, Thali MJ et al. Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography. Forensic Science, Medicine, and Pathology. 2017;13:170-6.","DOI":"10.1007\/s12024-017-9854-9"},{"key":"1043_CR16","unstructured":"Coroner\u2019s Court of Victoria. Coroners Act 2008. Available from: https:\/\/www.legislation.vic.gov.au\/in-force\/acts\/coroners-act-2008\/042. Accessed on 1 May 2025."},{"key":"1043_CR17","volume-title":"High-Sensitive Troponin-I [package insert]","author":"Abbott Laboratories","year":"2018","unstructured":"Abbott Laboratories. High-Sensitive Troponin-I [package insert]. Lake Bluff, IL: Abbott Laboratories: G97079R01; 2018."},{"key":"1043_CR18","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/0002-9149(61)90428-3","volume":"7","author":"BH Barbour","year":"1961","unstructured":"Barbour BH, Hirst A Jr, Johns V Jr. Nontraumatic hemopericardium. An analysis of 105 cases. Am J Cardiol. 1961;7:102\u20138.","journal-title":"Am J Cardiol"},{"key":"1043_CR19","unstructured":"Pawel B, Natalia B, Nazarenko N, Shaunak M, Akunor HS. Hemopericardium: a comprehensive clinical review of etiology and diagnosis. Cureus. 2024;16(1):e52677."},{"key":"1043_CR20","doi-asserted-by":"crossref","unstructured":"Koechlin L, Boeddinghaus J, Lopez-Ayala P, Nestelberger T, Miro O, Wussler D, et al. Performance of high-sensitivity cardiac troponin T versus I for the early diagnosis of myocardial infarction. Eur Heart J. 2022;43(Supplement_2):1339.","DOI":"10.1093\/eurheartj\/ehac544.1339"}],"container-title":["Forensic Science, Medicine and Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12024-025-01043-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12024-025-01043-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12024-025-01043-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:27:49Z","timestamp":1777544869000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12024-025-01043-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,10]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["1043"],"URL":"https:\/\/doi.org\/10.1007\/s12024-025-01043-2","relation":{},"ISSN":["1556-2891"],"issn-type":[{"value":"1556-2891","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,10]]},"assertion":[{"value":"4 July 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Victorian Institute of Forensic Medicine (VIFM) Ethics Committee on the 26th of October 2022 (Project ID: 1247) which included a waiver of informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors have no relevant financial or non-financial interests to disclose. No funding was received for conducting this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The authors used ChatGPT 3\u20135 to help improve the readability and language of the manuscript. The authors reviewed and edited any suggestions as needed and take full responsibility for the content of the published article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Generative AI and AI-assisted technologies in the writing process"}}]}}