tetano
Editor, Senior Moderator
J Pathol Clin Res
. 2021 Apr 9.
doi: 10.1002/cjp2.212. Online ahead of print.
Characterisation of cardiac pathology in 23 autopsies of lethal COVID-19
Jasmin D Haslbauer[SUP] 1 [/SUP], Alexandar Tzankov[SUP] 1 [/SUP], Kirsten D Mertz[SUP] 2 [/SUP], Nathalie Schwab[SUP] 2 [/SUP], Ronny Nienhold[SUP] 2 [/SUP], Raphael Twerenbold[SUP] 3 [/SUP], Gregor Leibundgut[SUP] 4 [/SUP], Anna K Stalder[SUP] 1 [/SUP], Matthias Matter[SUP] 1 [/SUP], Katharina Glatz[SUP] 1 [/SUP]
Affiliations
Abstract
While coronavirus disease 2019 (COVID-19) primarily affects the respiratory tract, pathophysiological changes of the cardiovascular system remain to be elucidated. We performed a retrospective cardiopathological analysis of the heart and vasculature from 23 autopsies of COVID-19 patients, comparing the findings with control tissue. Myocardium from autopsies of COVID-19 patients was categorised into severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive (n = 14) or negative (n = 9) based on the presence of viral RNA as determined by reverse transcriptase polymerase chain reaction (RT-PCR). Control tissue was selected from autopsies without COVID-19 (n = 10) with similar clinical sequelae. Histological characteristics were scored by ordinal and/or categorical grading. Five RT-PCR-positive cases underwent in situ hybridisation (ISH) for SARS-CoV-2. Patients with lethal COVID-19 infection were mostly male (78%) and had a high incidence of hypertension (91%), coronary artery disease (61%), and diabetes mellitus (48%). Patients with positive myocardial RT-PCR died earlier after hospital admission (5 versus 12 days, p < 0.001) than patients with negative RT-PCR. An increased severity of fibrin deposition, capillary dilatation, and microhaemorrhage was observed in RT-PCR-positive myocardium than in negatives and controls, with a positive correlation amongst these factors All cases with increased cardioinflammatory infiltrate, without myocyte necrosis (n = 4) or with myocarditis (n = 1), were RT-PCR negative. ISH revealed positivity of viral RNA in interstitial cells. Myocardial capillary dilatation, fibrin deposition, and microhaemorrhage may be the histomorphological correlate of COVID-19-associated coagulopathy. Increased cardioinflammation including one case of myocarditis was only detected in RT-PCR-negative hearts with significantly longer hospitalisation time. This may imply a secondary immunological response warranting further characterisation.
Keywords: COVID-19; SARS-CoV-2; haemorrhagic diathesis; microangiopathy; myocarditis.
. 2021 Apr 9.
doi: 10.1002/cjp2.212. Online ahead of print.
Characterisation of cardiac pathology in 23 autopsies of lethal COVID-19
Jasmin D Haslbauer[SUP] 1 [/SUP], Alexandar Tzankov[SUP] 1 [/SUP], Kirsten D Mertz[SUP] 2 [/SUP], Nathalie Schwab[SUP] 2 [/SUP], Ronny Nienhold[SUP] 2 [/SUP], Raphael Twerenbold[SUP] 3 [/SUP], Gregor Leibundgut[SUP] 4 [/SUP], Anna K Stalder[SUP] 1 [/SUP], Matthias Matter[SUP] 1 [/SUP], Katharina Glatz[SUP] 1 [/SUP]
Affiliations
- PMID: 33837673
- DOI: 10.1002/cjp2.212
Abstract
While coronavirus disease 2019 (COVID-19) primarily affects the respiratory tract, pathophysiological changes of the cardiovascular system remain to be elucidated. We performed a retrospective cardiopathological analysis of the heart and vasculature from 23 autopsies of COVID-19 patients, comparing the findings with control tissue. Myocardium from autopsies of COVID-19 patients was categorised into severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive (n = 14) or negative (n = 9) based on the presence of viral RNA as determined by reverse transcriptase polymerase chain reaction (RT-PCR). Control tissue was selected from autopsies without COVID-19 (n = 10) with similar clinical sequelae. Histological characteristics were scored by ordinal and/or categorical grading. Five RT-PCR-positive cases underwent in situ hybridisation (ISH) for SARS-CoV-2. Patients with lethal COVID-19 infection were mostly male (78%) and had a high incidence of hypertension (91%), coronary artery disease (61%), and diabetes mellitus (48%). Patients with positive myocardial RT-PCR died earlier after hospital admission (5 versus 12 days, p < 0.001) than patients with negative RT-PCR. An increased severity of fibrin deposition, capillary dilatation, and microhaemorrhage was observed in RT-PCR-positive myocardium than in negatives and controls, with a positive correlation amongst these factors All cases with increased cardioinflammatory infiltrate, without myocyte necrosis (n = 4) or with myocarditis (n = 1), were RT-PCR negative. ISH revealed positivity of viral RNA in interstitial cells. Myocardial capillary dilatation, fibrin deposition, and microhaemorrhage may be the histomorphological correlate of COVID-19-associated coagulopathy. Increased cardioinflammation including one case of myocarditis was only detected in RT-PCR-negative hearts with significantly longer hospitalisation time. This may imply a secondary immunological response warranting further characterisation.
Keywords: COVID-19; SARS-CoV-2; haemorrhagic diathesis; microangiopathy; myocarditis.