Microscopic cardiac pathology in forensic autopsies: a comparative study of anabolic androgenic steroid users and non-users.

Purpose: Anabolic androgenic steroid (AAS) abuse is a known risk factor for left ventricular (LV) hypertrophy and cardiac fibrosis. However, these changes are not exclusive to AAS abuse, and similar pathology is often observed in other types of cardiomyopathies. In this study, postmortem cardiac tissue specimens of AAS screened cases were re-examined in detail to determine, whether specific histopathological features could further support the detection of AAS abuse in forensic cause-of-death investigations.

Methods: The sample comprised of 46 Finnish forensic autopsy cases, including 16 AAS positive and 30 AAS negative males, autopsied between 2016 and 2019. Microscopic histopathological features and interstitial lymphocytic inflammation in cardiac tissue were analysed using haematoxylin & eosin (HE), Herovici, and CD3 immunohistochemical staining.

Results: While overall frequencies of arteriolosclerosis, cardiomyocyte hypertrophy, disarray, and fibrosis were similar between the groups, AAS positive cases tended to exhibit more interstitial type LV fibrosis, which was either diffuse or favouring the subepicardial layers. In contrast, right ventricular (RV) fibrosis was absent in AAS positive cases but present in 50% of AAS negative cases. Lymphocytic infiltration was lower in AAS positive cases, with significant differences in LV CD3 + cell densities.

Conclusion: This study highlights that light microscopic examination of cardiac tissue may have limited capacity in distinguishing AAS users from non-users postmortem. However, specific patterns of fibrosis were discovered that may represent histopathological features associated with AAS abuse. Future studies should include larger samples to allow for more robust control of confounding factors and to assess the generalizability of these findings.