Abstract
Introduction. Clinical and morphological aspects of myocardial pathology and thrombotic microangiopathy (TMA) in COVID-19 were studied a little due to the tense epidemiological situation in the СOVID-19 pandemic. The aim of the study was to give a comprehensive assessment of clinical and morphological pathological features of the myocardium in patients with COVID-19 in the fourth wave of the infection. Materials and methods. We analyzed clinical and morphological data in 11 patients with clinically diagnosed myocarditis according to the echocardiography and electrocardiography (ECG) findings. In 7 cases, we evaluated antemortem clinical results, and in 5 cases, we performed a complex clinical and morphological autopsy study. We also assessed TMA using coagulogram results and platelet count data. Results. Pathological evaluation revealed cardiomyocyte hypertrophy with myocytolysis. Using histochemical methods (Mallory and Lee stains) and IHC assays with antibodies to CD3, CD4, CD8, CD20, CD45, and CD68 we confirmed the lymphocytic infiltrate in the myocardial stroma with single leukocytes, fibrosis foci, and damaged cardiomyocytes. Conclusion. MRI with contrast and endomyocardial biopsy (EMB) with IHC assay are the gold standard to diagnose myocarditis. The obtained data enable us to assess clinical and laboratory diagnosis of myocarditis and TMA more thoroughly as well as modify treatment.
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