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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Comparative Study of the Myocardium of Patients from Four COVID-19 Waves

Lubov Borisovna Mitrofanova1, Igor Aleksandrovich Makarov1, Andrey Nikolaevich Gorshkov1,2

  • 1Almazov National Medical Research Centre, St. Petersburg 197341, Russia.

Diagnostics (Basel, Switzerland)
|May 13, 2023
PubMed

Insights

This study found that cardiovascular complications like myocarditis decreased over time in COVID-19 patients. However, a direct link between SARS-CoV-2 infection and myocarditis remains unproven.

Area of Science:

  • Pathology
  • Virology
  • Cardiology

Background:

  • Limited research exists on comparing COVID-19 patients across different pandemic waves.
  • Understanding clinical and morphological changes in deceased COVID-19 patients is crucial.

Purpose of the Study:

  • To conduct a clinical and morphological analysis of patients who died from COVID-19 across four distinct waves.
  • To compare the incidence of myocardial damage and cardiovascular complications over successive COVID-19 waves.

Main Methods:

  • Autopsy myocardium samples from 276 deceased COVID-19 patients (across three waves) were histologically examined.
  • Immunohistochemistry, immunofluorescence, RT-ddPCR, and electron microscopy were employed to detect viral presence and cellular changes.
  • Analysis included markers for inflammation, endothelial damage, and viral proteins (enteroviral VP1, SARS-CoV-2 spike protein).

Main Results:

  • Active myocarditis was diagnosed in 5% of cases; 86% expressed VP1, and 22% had SARS-CoV-2 spike protein in individual cells.
  • Electron microscopy revealed potential SARS-CoV-2 virions on the endothelium of myocardial vessels.
  • Incidence of hemorrhage, myocardial necrosis, blood clots, and myocarditis significantly decreased over the waves, with CD8-T-killers appearing.

Conclusions:

  • Myocardial damage, including endotheliitis complications and myocarditis, decreased across the studied COVID-19 waves.
  • The direct causal link between SARS-CoV-2 infection and the observed myocarditis in these cases remains unproven.
  • Endotheliitis was confirmed in all immunohistochemically studied cases.
Abstract

Keywords:
COVID-19 wavesimmunofluorescent myocardial studyimmunohistochemicalmyocarditispolymerase chain reactionultrastructural myocardial study

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