Cardiac deaths with structural heart abnormalities in the young (0–49 years): a ten-year forensic autopsy review

The primary purpose of forensic autopsies is to assess third-party involvement in fatalities with a non-natural or undetermined manner of death. In a proportion of the latter, after completion of forensic examinations, a natural manner of death is ultimately attested. This study aimed to determine the proportion of natural deaths in individuals under 50 years of age, the frequency of cardiac deaths in this age group and the spectrum of causative structural cardiac pathologies. We carried out a retrospective analysis of all autopsies performed at our institute of legal medicine in Germany (n = 9244). Individuals aged 0–49 years with a natural manner of death and a cardiac cause of death with structural abnormalities comprised 192 cases. Data on cardiovascular risk factors, symptoms prior to death, and activity at the time of death were systematically collected. A key methodological focus was the individualized assessment of heart weight using predicted values based on age, sex, height, and weight. Ischemic heart disease was the most frequent cause of death (n = 76). Individualized comparison of measured and predicted heart weight demonstrated statistically significantly increased values, consistent with pathological cardiac hypertrophy. A high prevalence of clinically recognizable cardiovascular risk factors was observed. While ischemic heart disease remains the leading cardiac cause of death in this young cohort, the principal contribution of this study lies in its comprehensive methodological approach, particularly the individualized quantification of cardiac hypertrophy. The high prevalence of identifiable risk factors underscores the importance of early clinical risk stratification and preventive interventions in young individuals. Ischemic heart disease was the leading cardiac cause of death under age 50. Heart weight was significantly higher than expected in cardiac death cases. Early risk assessment and prevention of cardiac disease in the young is essential.