Comparison of cardiac calcium score and autopsy findings from postmortem isolated cardiac computed tomography

Determining the cause of death in cases of suspicious deaths is one of the important challenges in forensic medicine. Ischemic heart disease is the most common cause of sudden death in Western countries, and coronary artery disease accounts for the majority of cases. Limited access to postmortem anamnesis and clinical methods complicates the detection of coronary artery disease. The Agatston Score is a method that can measure calcium deposits in various tissues, including the coronary arteries, aorta, heart valves, carotid and femoral arteries, using computed tomography. The coronary artery calcium score is a reliable and non-invasive technique generally used to estimate coronary plaque burden and determine future cardiac event risk. Cardiac advanced imaging techniques can be used as complementary methods in forensic cases, such as in diagnosis, risk stratification, and treatment of patients, as well as in postmortem etiology diagnosis. The coronary artery calcium scoring method can also be used as an auxiliary method in cardiac deaths. The aim of our study was to investigate the relationship between Agatston scores and coronary artery atherosclerosis and deaths related to coronary artery disease, as well as to determine the applicability of isolated cardiac computed tomography in forensic practice. After the hearts of the cases that underwent medico-legal autopsy were separated from other thoracic organs, they were placed in a suitable container that would not interfere with imaging and isolated cardiac computed tomography was performed without disrupting routine autopsy procedures. Then, computed tomography images were examined and Agatston Scores were calculated using the Agatston scoring program. According to the findings, in deaths related to coronary artery disease, the Agatston Score was significantly higher compared to other causes of death, and cases with evidence of myocardial infarction had a significantly higher Agatston Score than those without. It was also found that the degree of stenosis related to coronary artery atherosclerosis was correlated with the Agatston score. Additionally, it was observed that a CACS >0 value had high sensitivity and NPD for detecting coronary artery stenosis, and a CACS >400 value had high specificity. Based on our research and literature review, it was concluded that postmortem CACS measurement could be used as a guide in detecting coronary artery disease in forensic practice, but it was not conclusive evidence for determining the cause of death alone.