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Microtrombos como una causa importante de lesión cardíaca en el COVID-19: un estudio patológico
Dario Pellegrini1, Rika Kawakami2, Giulio Guagliumi1
1Ospedale Papa Giovanni XXIII, Bergamo, Italy (D.P., G.G., A.G., A.N., L.F., I.P., M.B.).
Circulation
|January 22, 2021
Resumen
Los microthrombos, no la enfermedad de las arterias coronarias, fueron la causa principal de lesión cardíaca y necrosis de los miocitos en pacientes con COVID-19. Estos microtrombos, ricos en fibrina y complemento, sugieren que las estrategias antitrombóticas personalizadas pueden ayudar a mitigar el daño cardíaco de la infección por SARS-CoV-2.
Área de la Ciencia:
- Cardiología
- Patología
- Enfermedades infecciosas
Sus antecedentes:
- La lesión cardíaca es una complicación frecuente del COVID-19, asociada con un peor pronóstico.
- Los mecanismos precisos y la naturaleza del daño miocárdico causado por el SARS-CoV-2 siguen sin estar claros.
Objetivo del estudio:
- Investigar los mecanismos patológicos de la lesión cardíaca en pacientes fallecidos por COVID-19.
- Para identificar las causas subyacentes de la necrosis de los miocitos en el contexto de la infección por SARS-CoV-2.
Principales métodos:
- Análisis patológico sistemático de 40 corazones de las muertes por COVID-19.
- Categoría de los corazones basada en la presencia o ausencia de necrosis aguda de los miocitos.
- Análisis comparativo de la composición de microtrombios cardíacos en los casos de COVID-19 frente a los controles.
Principales resultados:
- Se observó necrosis de los miocitos en el 35% de los casos, principalmente en el ventrículo izquierdo.
- Los microthrombos en los capilares miocárdicos y las arterias pequeñas fueron la causa predominante de la necrosis, encontrada en el 64,3% de los casos necróticos.
- Los microthrombos asociados con COVID-19 mostraron un aumento de la fibrina y la deposición de C5b-9 en comparación con otros tipos de trombos.
Conclusiones:
- Los microthrombos son el principal conductor patológico de la necrosis de los miocitos en el COVID-19.
- La composición de estos microthrombos difiere significativamente de otros eventos trombóticos.
- El desarrollo de terapias antitrombóticas específicas podría ser crucial para el manejo de las complicaciones cardíacas del COVID-19.
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