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Cardiac inflammation and microvascular procoagulant changes are decreased in second wave compared to first wave

Linghe Wu1, Umit Baylan2, Britt van der Leeden3

  • 1Dept. of Pathology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centre (AUMC), location VUmc, De Boelelaan 1017, 1081HV Amsterdam, the Netherlands.

International Journal of Cardiology
|December 6, 2021
PubMed

Insights

Cardiac inflammation and injury were significantly lower in second wave COVID-19 patients compared to the first wave. This suggests improved COVID-19 treatments, possibly due to increased steroid use, may reduce cardiac pathology.

Area of Science:

  • Cardiovascular Pathology
  • Infectious Diseases
  • Immunology

Background:

  • Cardiac involvement is a known complication of COVID-19.
  • Previous studies primarily focused on the first wave of the pandemic.
  • Emerging evidence suggests differences in disease course and mortality between COVID-19 waves.

Purpose of the Study:

  • To analyze and compare cardiac pathology in COVID-19 patients between the first and second waves.
  • To investigate changes in cardiac inflammation, cardiomyocyte injury, and microvascular thrombogenicity.

Main Methods:

  • (Immuno)histochemical analysis of autopsied hearts from first-wave (n=15), second-wave (n=10) COVID-19 patients, and controls (n=18).
  • Quantification of leukocyte, macrophage, and T lymphocyte infiltration.
  • Assessment of cardiomyocyte necrosis, microvascular thrombosis, and specific procoagulant/anticoagulant factors (Tissue Factor, Factor VII, Factor XII, DPP4, CML).

Main Results:

  • Significantly decreased cardiac inflammation in second-wave patients, primarily due to reduced lymphocyte infiltration and lymphocytic myocarditis.
  • Accompanied by significant reductions in cardiomyocyte injury and microvascular thrombosis in second-wave patients.
  • Lower microvascular deposits of Factor VII and CML observed in second-wave COVID-19 hearts.

Conclusions:

  • Cardiac inflammation, cardiomyocyte injury, and microvascular thrombogenicity were markedly reduced in second-wave COVID-19 patients compared to the first wave.
  • These findings may indicate the positive impact of evolving COVID-19 treatment strategies.
  • Increased use of steroids during the second wave could be a contributing factor to the observed decrease in cardiac pathology.
Abstract

Keywords:
COVID-19First and second waveHeartInflammationThrombosis microvasculature

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