Abstract
The role of SARS-CoV-2 as a direct cause in the cardiac lesions in patients with severe COVID-19 remains to be established. Our objective is to report the pathological findings in cardiac samples of 30 patients who died after a prolonged hospital stay due to Sars-Cov-2 infection. We performed macroscopic, histological and immunohistochemical analysis of the hearts of 30 patients; and detected Sars-Cov-2 RNA by RT-PCR in the cardiac tissue samples. The median age of our cohort was 69.5 years and 76.6% were male. The median time between symptoms onset and death was 36.5 days. The main comorbidities were arterial hypertension (13 patients, 43.3%), dyslipidemia (11 patients, 36.7%), cardiovascular conditions (8 patients, 26.7%), and obesity (8 patients, 26.7%). Cardiovascular conditions included ischemic cardiopathy in 4 patients (13.3%), hypertrophic cardiomyopathy in 2 patients (6.7%) and valve replacement and chronic heart failure in one patient each (3.3%). At autopsy, the most frequent histopathological findings were coronary artery atherosclerosis (8 patients, 26.7%), left ventricular hypertrophy (4 patients, 13.3%), chronic epicardial inflammation (3 patients, 10%) and adipose metaplasia (2 patients, 6.7%). Two patients showed focal myocarditis, one due to invasive aspergillosis. One additional patient showed senile amyloidosis. Sars-Cov-2 RNA was detected in the heart of only one out of 30 patients, who had the shortest disease evolution of the series (9 days). However, no relevant cardiac histological alterations were identified. In present series, cardiac pathology was only modest in most patients with severe COVID-19. At present, the contribution of a direct effect of SARS-CoV-2 on cardiac lesions remains to be established.
Highlights
Coronavirus-19 disease (COVID-19), caused by the new coronavirus SARS-CoV-2 has become a global health challenge in our time [1]
As cardiovascular complications including myocarditis, acute myocardial infarction, and exacerbation of heart failure are present in patients suffering from other respiratory viral infections, such as influenza virus each annual epidemic period, special attention has been paid to a possible heart involvement by SARS-CoV-2 since the beginning of the pandemic [5]
The objective of our study is to present the histopathological cardiac lesions in a series of 30 autopsies performed in patients who died by severe COVID-19 with relative long-term evolution from symptoms onset
Summary
Coronavirus-19 disease (COVID-19), caused by the new coronavirus SARS-CoV-2 has become a global health challenge in our time [1]. It is known that SARS-CoV-2 affects mainly the respiratory system, with a spectrum of clinical manifestations ranging from asymptomatic to mild illness with fever and fatigue (80% of symptomatic patients) [2]. As cardiovascular complications including myocarditis, acute myocardial infarction, and exacerbation of heart failure are present in patients suffering from other respiratory viral infections, such as influenza virus each annual epidemic period, special attention has been paid to a possible heart involvement by SARS-CoV-2 since the beginning of the pandemic [5]. The possible pathophysiological mechanisms by which SARS-CoV-2 would cause damage to the myocardium and vascular endothelium include a direct myocardial injury due to viral invasion, a damage secondary to hypoxemia as consequence of respiratory failure, infarct secondary to thrombosis, as well as a dysregulated immunological response (known as cytokine storm) [8]
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