Letale pulmonale Fettembolie: Assoziation mit Myokardhypertrophie

Pulmonary fat embolism (PFE) is a condition that can occur after trauma or surgery, among other events. Obstruction of the pulmonary circulation by fatty particles can lead to cardiorespiratory symptoms. The aim of this study was to determine clinical or pathophysiological risk factors, such as concomitant diseases and body characteristics, of individuals who died from PFE.

At the Institute of Forensic Medicine, Münster University Hospital, PFE was reported as the cause of death in 27 autopsies between 1993 and 2017. The autopsies and histology findings, Sudan staining, and histological grading of PFE according to Falzi form the basis of this study. The control group included 27 traumatic deaths (1995–2017) in which PFE could not be detected. Heart weight, body mass index (BMI), survival time, injury severity and chronic pulmonary emphysema (CLE) diagnosis were compared by the Mann-Whitney U test and χ²-test.

The gender distribution in the study and control groups was 63% women vs. 37% men. The age in the study group ranged from 56 years to 93 years vs. 51 years to 89 years in the control group. The mean BMI was 25.6 kg/m² in the study group and 25.3 kg/m² in the control group. CLE was present as a concomitant disease in 15 cases in the study group (56%) vs. 10 cases in the control group (37%). Myocardial hypertrophy was diagnosed in 20 cases (74%) in the study group. The mean myocardial weight was 434 g (female) and 496 g (male). A heart weight of 500 g was exceeded in 9 cases (33%). In the control group, the mean myocardial weight was 349 g (female) and 384 g (male), and a heart weight of 500 g was exceeded twice. The difference in the distribution of heart weights was statistically significant (p = 0.001) but not for the other parameters investigated.

In this relatively small study population, there was a statistically significant association between heart weight/myocardial hypertrophy and fatal PFE. If this result is confirmed in further studies, myocardial hypertrophy represents a risk factor for fatal PFE. A statistically significant association between BMI, survival times, injury severity or a diagnosis of CLE and death from PFE was not found.