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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Morphological changes without histological myocarditis in hearts of COVID-19 deceased patients

Ali Razaghi1, Attila Szakos2, Riham Al-Shakarji2

  • 1Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.

Scandinavian Cardiovascular Journal : SCJ
|June 9, 2022
PubMed

Insights

COVID-19 can harm the heart, but this study found no evidence of myocarditis in deceased patients. Instead, endothelial damage suggests a circulating factor from the lungs may be responsible for cardiac issues.

Area of Science:

  • Cardiology
  • Virology
  • Pathology

Background:

  • Patients with heart disease face higher COVID-19 mortality risks.
  • COVID-19's cardiac effects, particularly myocarditis, are not fully understood.
  • Research predominantly focuses on respiratory complications, leaving cardiac involvement understudied.

Purpose of the Study:

  • To investigate myocardial involvement in fatal COVID-19 cases.
  • To characterize histopathological changes and SARS-CoV-2 presence in heart tissue.
  • To determine the prevalence of myocarditis in COVID-19 fatalities.

Main Methods:

  • Autopsy heart tissues from 37 COVID-19 patients and 21 controls were analyzed.
  • A panel of antibodies was used to detect hypoxic and inflammatory changes.
  • RNA in situ hybridization was employed to detect viral replication.

Main Results:

  • COVID-19 hearts showed myocyte waviness, fibrosis, necrosis, and endothelial damage.
  • No viral replication or lymphocyte infiltration (hallmark of myocarditis) was detected.
  • Histopathological changes were observed, but not indicative of direct viral myocarditis.

Conclusions:

  • No histological evidence of myocarditis was found in the studied COVID-19 cases.
  • Findings support a hypothesis of circulating endothelium-activating factors, possibly VEGF.
  • These factors may originate from hypoxic lung tissue in COVID-19 patients.

Keywords:
COVID-19Myocarditishearthypoxiainflammation

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