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COVID-19-Associated cardiac pathology at the postmortem evaluation: a collaborative systematic review

Raghed Almamlouk1, Tarek Kashour2, Sawsan Obeidat1

  • 1College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|March 27, 2022
PubMed

Insights

This systematic review of 50 autopsy studies reveals high rates of acute and chronic cardiac pathologies in COVID-19 patients. SARS-CoV-2 was frequently detected in the myocardium, but myocarditis was rare.

Area of Science:

  • Cardiovascular Pathology
  • Infectious Diseases
  • Autopsy Studies

Background:

  • Previous postmortem studies on COVID-19 cardiovascular effects had small sample sizes.
  • Understanding the full spectrum of cardiac complications requires larger data aggregation.

Purpose of the Study:

  • To systematically review autopsy studies on COVID-19 cardiovascular complications.
  • To pool data from numerous autopsy studies to better understand cardiac pathology in COVID-19.
  • To investigate the prevalence of acute and chronic cardiac findings and SARS-CoV-2 presence in the myocardium.

Main Methods:

  • Systematic search of multiple online databases (Ovid, Scopus, Web of Science) and medRxiv for autopsy/histopathology studies combined with COVID-19.
  • Inclusion criteria: human postmortem cardiovascular findings in confirmed SARS-CoV-2 infection cases.
  • Risk of bias assessment and calculation of median prevalence with interquartile ranges for various cardiac findings.

Main Results:

  • The review included 50 studies with 548 hearts; median age of deceased was 69 years.
  • Most prevalent acute findings: myocardial necrosis (100%) and edema (55.5%).
  • Most prevalent chronic changes: myocyte hypertrophy (69.0%) and fibrosis (35.0%). SARS-CoV-2 was detected in the myocardium in 60.8% of cases. Myocarditis prevalence was low (0.0%).

Conclusions:

  • COVID-19 is associated with a high prevalence of both acute and chronic cardiac pathologies.
  • Evidence supports SARS-CoV-2 cardiac tropism.
  • The prevalence of myocarditis in COVID-19, based on autopsy findings, is low.
Abstract

Keywords:
COVID-19Cardiac pathologyMyocarditisPostmortemSARS-CoV-2Systematic review

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