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Microthrombi as a Major Cause of Cardiac Injury in COVID-19: A Pathologic Study
Dario Pellegrini1, Rika Kawakami2, Giulio Guagliumi1
1Ospedale Papa Giovanni XXIII, Bergamo, Italy (D.P., G.G., A.G., A.N., L.F., I.P., M.B.).
Circulation
|January 22, 2021
Summary
Microthrombi, not coronary artery disease, were the primary cause of cardiac injury and myocyte necrosis in COVID-19 patients. These microthrombi, rich in fibrin and complement, suggest tailored antithrombotic strategies may help mitigate cardiac damage from SARS-CoV-2 infection.
Area of Science:
- Cardiology
- Pathology
- Infectious Diseases
Background:
- Cardiac injury is a frequent complication of COVID-19, associated with a worse prognosis.
- The precise mechanisms and nature of myocardial damage caused by SARS-CoV-2 remain unclear.
Purpose of the Study:
- To investigate the pathological mechanisms of cardiac injury in patients deceased from COVID-19.
- To identify the underlying causes of myocyte necrosis in the context of SARS-CoV-2 infection.
Main Methods:
- Systematic pathological analysis of 40 hearts from COVID-19 fatalities.
- Categorization of hearts based on the presence or absence of acute myocyte necrosis.
- Comparative analysis of cardiac microthrombi composition in COVID-19 cases versus controls.
Main Results:
- Myocyte necrosis was observed in 35% of cases, primarily in the left ventricle.
- Microthrombi in myocardial capillaries and small arteries were the predominant cause of necrosis, found in 64.3% of necrotic cases.
- COVID-19-associated microthrombi showed increased fibrin and C5b-9 deposition compared to other thrombus types.
Conclusions:
- Microthrombi are the main pathological driver of myocyte necrosis in COVID-19.
- The composition of these microthrombi differs significantly from other thrombotic events.
- Developing specific antithrombotic therapies could be crucial for managing cardiac complications of COVID-19.
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