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The Effectiveness and Limitations of Triphenyltetrazolium Chloride to Detect Acute Myocardial Infarction at Forensic Autopsy

Kakimoto, Yu MD*; Tsuruyama, Tatsuaki MD, PhD*; Miyao, Masashi MD*; Abiru, Hitoshi BS*; Sumiyoshi, Shinji MD, PhD; Kotani, Hirokazu MD, PhD*; Haga, Hironori MD, PhD; Tamaki, Keiji MD, PhD*

The American Journal of Forensic Medicine and Pathology: September 2013 - Volume 34 - Issue 3 - p 242–247
doi: 10.1097/PAF.0b013e31828879cd
Original Articles

Triphenyltetrazolium chloride (TTC) is one of the most conventional stains to detect infarcted area of the heart in animal experiments. However, its availability and limitations have not been thoroughly discussed in the forensic field. Here, authors stained human hearts with TTC soon after the harvest. Photographs of the samples were analyzed using image analysis software, which evaluated the occupying ratio of the stained area on the surface of each slice. The results showed that the stainability of TTC declines with the length of the postmortem interval (PMI). Specimens reacted well to TTC within 1.5 days after death and then decreased the stainability logarithmically with PMI (y = − 0.294 In (x) + 1.0441; x = PMI, y = TTC-stained area / total myocardial area, R 2 = 0.5673). Samples with old myocardial infarction produced clear TTC contrast; normal tissue is vivid red, and fibrotic myocardium is white discoloration. In acute myocardial infarction cases where death occurred within 9 hours after the attack, however, the detection of infarcted area was very difficult even when PMI was less than 1.5 days. In summary, the TTC method may be useful within 1.5 days after death, but short suffering period before death disturbs its staining efficiency.

From the *Department of Forensic Medicine and Molecular Pathology, Kyoto University Graduate School of Medicine; and †Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.

Manuscript received March 14, 2012; accepted September 6, 2012.

This study receives no official funds or grants.

The authors report no conflicts of interest.

Reprints: Keiji Tamaki, MD, PhD, Department of Forensic Medicine and Molecular Pathology, Kyoto University Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. E-mail:

© 2013 by Lippincott Williams & Wilkins.