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Microtrombos de fibrina no oclusiva asociados con el COVID-19 en el corazón

Melanie C Bois¹, Nicholas A Boire¹, Andrew J Layman¹

¹Department of Laboratory Medicine and Pathology (M.C.B., N.A.B., A.J.L., M.-C.A., M.P.A., A.C.R., C.E.H., R.A.Q., R.M., B.R.K., P.T.L., J.J.M.), Mayo Clinic, Rochester, MN.

|November 16, 2020

Resumen

Este estudio no encontró infección cardíaca directa por SARS-CoV-2, pero reveló microtrombias de fibrina cardíaca comunes en pacientes con COVID-19. La miocarditis estuvo presente en algunos casos, y la amiloidosis cardíaca puede empeorar los resultados graves de COVID-19.

Área de la Ciencia:

Cardiología
Virología
Patología

Sus antecedentes:

El coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2) causa COVID-19, una amenaza global para la salud con frecuentes complicaciones cardíacas.
Los mecanismos precisos detrás de los problemas cardíacos relacionados con el COVID-19 siguen siendo en gran medida desconocidos.
Las evaluaciones cardíacas postmortem son cruciales para comprender la patología de la infección por SARS-CoV-2.

Objetivo del estudio:

Para detallar el espectro patológico miocárdico en pacientes con COVID-19.
Para comparar los hallazgos cardíacos en COVID-19 con otras enfermedades virales.
Investigar la expresión de la enzima convertidora de angiotensina 2 (ACE2) en el corazón y describir los hallazgos cardíacos en casos de infección eliminados.

Principales métodos:

Evaluación cardíaca postmortem de los casos de COVID-19 (n=15), la gripe (n=6) y el grupo de control (n=6).
Análisis histopatológico, inmunohistoquímica para ACE2, examen ultrastructural y RT-PCR para la detección viral.
Comparación de los hallazgos entre diferentes grupos de enfermedades y estados clínicos (infección activa vs. eliminada).

Principales resultados:

Los microtrombos de fibrina no específicos fueron comunes en los casos activos de COVID-19 (P=0,006).
Se observó miocarditis focal en casos activos (33,3%) y eliminados de COVID-19, generalmente de alcance limitado.
Se observó una menor expresión endotelial de ACE2 en los casos de COVID-19 (P=0,004), pero la expresión de ACE2 en el miocardio no fue diferente.
La amiloidosis cardíaca se identificó en el 26,7% de los pacientes con COVID-19.

Conclusiones:

No se identificó definitivamente ninguna infección miocárdica directa por SARS-CoV-2.
Los microtromos de fibrina cardíaca son frecuentes en el COVID-19, pero no están universalmente relacionados con la lesión isquémica.
La miocarditis ocurre en un subconjunto de pacientes con COVID-19, con una presentación variable en infecciones eliminadas.
La amiloidosis cardíaca puede representar un factor de riesgo adicional para la enfermedad grave por COVID-19.

Palabras clave:

El COVID-19 En el caso del SARS-CoV-2 la autopsia el corazón patología

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