Application of computational programs in autopsy: new horizons of pathology practice

According to the IV Universal Definition of Myocardial Infarction, there are 5 types of the disease, with 3 subtypes in type 4. In pathologoanatomic practice, there are difficulties in differentiating myocardial infarction of type 1 and type 2 when there is no acute coronary injury during autopsy. Now pathologic anatomy has a large stock of techniques and methods, including the use of computational technology and statistical data processing. The introduction of computational programs for retrospective assessment of the circulatory state will help to increase the level and evidence of pathological anatomical studies.
The aim of the work is to analyze autopsy cases of acute myocardial infarction using computational programs.
Material and methods. The computational program “Quantitative assessment of heart failure in the postmortem period” developed by the authors and based on the database “Patients with heart failure in the terminal period” was used in the work. The program calculates the cardiac index according to Y. Starr, Baevsky adaptation index and classifies variants of functional circulatory failure.
Results. According to the IV universal definition of myocardial infarction the observations were distributed as follows: myocardial infarction type 1 (MI1T) - 34, MI2T - 29, MI4aT - 6, MI4bT - 6 and MI5T - 2 cases. Myocardial infarctions of types 3 and 4c were categorized as clinical concepts and were not included in the study. Within our analysis, IM2T was found to have the smallest area of cardiac necrosis (Me 4.0 (3.0-12.5)) and significantly smaller compared to IM1T (p=0.0137). Application of the computer program revealed the 1st and 2nd variants of functional circulatory disturbance only in MI2T, which in turn indicates an extracardiac effect on the heart and thus can be considered as a complication of other underlying pathology. To verify the accuracy of the computer program, the sensitivity and specificity of the test were calculated. Acute heart failure was taken as a criterion, characterized by Y. Starr as moderate, severe, and critical, corresponding to options 3, 4, and 5 of the FCD classification.
Conclusion. The proposed computational program, as an additional method, helps to qualitatively analyze hemodynamic disturbances in the heart without making a hard and long autopsy. The computer program calculates indices of acute heart failure occurring during myocardial infarction, is characterized by high accuracy of the test, and sensitivity and specificity are 94.57% and 100%, respectively.

1. Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, Bernard R Chaitman, Jeroen J Bax, David A Morrow, Harvey D White, ESC Scientific Document Group, Fourth universal definition of myocardial infarction (2018), European Heart Journal. 14 January 2019;40(3):237- 269. (in Engl) https://doi.org/10.1093/eurheartj/ehy462

2. Lushnikov EF. Methods and methodology of pathology. Russian Journal of Archive of Pathology. 2016;78(5):50-55. (in Russ.). https://doi.org/10.17116/patol201678550-55

3. Starr Y. Clinical tests of the simple method of estimating cardiac stroke volume from blood pressure and age. Circulation. 1954 May; 9(5):664-81. (in Engl) doi: 10.1161/01.cir.9.5.664. PMID: 13161098.

4. Baevskii P.M., Berseneva A.P. Otsenka adaptatsionnykh vozmozhnostei organizma i risk razvitiya zabolevanii (Assessment of adaptation of body conditions and risks of disease development). Moscow: Meditsina, 1997:236. (in Russ.).

5. Zairat'yants, O.V., Mishnev O.D., Kakturskii L.V. Infarkt miokarda i ostryi koronarnyi sindrom: definitsii, klassifikatsiya i kriterii diagnostiki (Myocardial infarction and acute coronary syndrome: Definitions, classification, and diagnostic criteria). Arkhiv patologii. 2014;76(6):3-11. (In Russ)