ESC Heart Fail . COVID-19-associated myocardial injury: A case report

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ESC Heart Fail


. 2023 Jan 24.
doi: 10.1002/ehf2.14295. Online ahead of print.
COVID-19-associated myocardial injury: A case report


Tomonori Tadokoro ¹ , Keiko Ohta-Ogo ² , Yoshihiko Ikeda ² , Masaya Sugiyama ³ , Harutaka Katano ⁴ , Kinta Hatakeyama ² , Masanori Matsumoto ⁵ , Hideki Tashiro ¹



Affiliations

• PMID: 36691883
• DOI: 10.1002/ehf2.14295

Abstract

Coronavirus disease 2019 (COVID-19) is often accompanied by pneumonia and can be fatal. We report a case of COVID-19-associated myocardial injury mimicking fulminant myocarditis. Endomyocardial biopsy revealed numerous von Willebrand factor-rich microthrombi with small myocardial necrotic areas, complement deposits in small vessels/microthrombi, and macrophage-predominant interstitial infiltration. These findings, distinct from those of typical lymphocytic myocarditis, show diffuse endothelial injury, complement activation, and activated macrophages as characteristic features of COVID-19-associated pathogenesis. Dysregulated serum cytokine profiles predicting severe/critical COVID-19-associated myocardial injury were also determined. This case emphasizes the occurrence of fatal cardiac manifestation with microthrombotic injury in the early stage of COVID-19.

Keywords: COVID-19; Complement; Endothelial injury; Macrophage infiltration; Microthrombi; Myocardial injury.