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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.
Summary
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.
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