Confirmation of cause and manner of death via a comprehensive cardiac autopsy including whole exome next-generation sequencing.

Arch Pathol Lab Med

From the Mayo Medical School, Rochester, Minnesota (Ms Loporcaro); the Departments of Internal Medicine/Division of Cardiovascular Diseases (Mr Tester and Dr Ackerman), Laboratory Medicine & Pathology, Division of Anatomic Pathology (Dr Maleszewski), Laboratory Medicine & Pathology, Division of Laboratory Genetics (Ms Kruisselbrink), Molecular Pharmacology & Experimental Therapeutics (Dr Ackerman), and Pediatric and Adolescent Medicine/Division of Pediatric Cardiology (Dr Ackerman), and the Windland Smith Rice Sudden Death Genomics Laboratory (Mr Tester and Dr Ackerman), Mayo Clinic, Rochester, Minnesota.

Published: August 2014

Annually, the sudden death of thousands of young people remains inadequately explained despite medicolegal investigation. Postmortem genetic testing for channelopathies/cardiomyopathies may illuminate a potential cardiac mechanism and establish a more accurate cause and manner of death and provide an actionable genetic marker to test surviving family members who may be at risk for a fatal arrhythmia. Whole exome sequencing allows for simultaneous genetic interrogation of an individual's entire estimated library of approximately 30000 genes. Following an inconclusive autopsy, whole exome sequencing and gene-specific surveillance of all known major cardiac channelopathy/cardiomyopathy genes (90 total) were performed on autopsy blood-derived genomic DNA from a previously healthy 16-year-old adolescent female found deceased in her bedroom. Whole exome sequencing analysis revealed a R249Q-MYH7 mutation associated previously with familial hypertrophic cardiomyopathy, sudden death, and impaired β-myosin heavy chain (MHC-β) actin-translocating and actin-activated ATPase (adenosine triphosphatase) activity. Whole exome sequencing may be an efficient and cost-effective approach to incorporate molecular studies into the conventional postmortem examination.

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http://dx.doi.org/10.5858/arpa.2013-0479-SADOI Listing

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