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COVID-19-associated myocardial injury: A case report

Tomonori Tadokoro1, Keiko Ohta-Ogo2, Yoshihiko Ikeda2

  • 1Department of Cardiovascular Medicine, St. Mary's Hospital, Kurume, Japan.

ESC Heart Failure
|January 24, 2023
PubMed

Insights

This study details a fatal case of COVID-19-associated myocardial injury, showing microthrombi and endothelial damage, not typical myocarditis. It highlights early cardiac microthrombotic injury as a severe manifestation of coronavirus disease 2019.

Area of Science:

  • Cardiovascular Pathology
  • Infectious Disease Pathogenesis
  • Immunopathology

Background:

  • Coronavirus disease 2019 (COVID-19) can lead to severe complications, including cardiac involvement.
  • Myocardial injury in COVID-19 can mimic other cardiac conditions, complicating diagnosis and treatment.
  • Understanding the specific mechanisms of COVID-19 cardiac pathology is crucial for managing severe cases.

Observation:

  • A case of COVID-19 presented with myocardial injury that initially resembled fulminant myocarditis.
  • Endomyocardial biopsy revealed extensive microthrombi rich in von Willebrand factor within small vessels.
  • Histopathology showed complement deposition, macrophage infiltration, and small areas of myocardial necrosis.

Findings:

  • The observed pathology demonstrated diffuse endothelial injury and complement activation, distinct from typical lymphocytic myocarditis.
  • Activated macrophages played a significant role in the observed interstitial infiltration.
  • Specific serum cytokine profiles correlated with the severity of myocardial injury in COVID-19.

Implications:

  • These findings suggest that microthrombotic injury and endothelial dysfunction are key features of severe COVID-19 cardiac pathology.
  • Early identification of microthrombotic injury may be critical for managing fatal cardiac manifestations of COVID-19.
  • The study underscores the importance of considering COVID-19-associated microvascular injury in patients with unexplained cardiac events.

Keywords:
COVID-19ComplementEndothelial injuryMacrophage infiltrationMicrothrombiMyocardial injury

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