Abstract
Coronavirus disease 2019 (COVID-19) can potentially affect all organs owing to the ubiquitous diffusion of the angiotensin-converting enzyme II (ACE2) receptor-binding protein. Indeed, the SARS-CoV-2 virus is capable of causing heart disease. This systematic review can offer a new perspective on the potential consequences of COVID-19 through an analysis of the current literature on cardiac involvement. This systematic review, conducted from March 2020 to July 2021, searched the current literature for postmortem findings in patients who were positive for SARS-CoV-2 by combining and meshing the terms “COVID-19”, “postmortem”, “autopsy”, and “heart” in titles, abstracts, and keywords. The PubMed database was searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixteen papers met the inclusion criteria (case reports and series, original research, only English-written). A total of 209 patients were found (mean age (interquartile range (IQR)), 60.17 years (IQR, 54.75–70.75 years); 122 men (58.37%, ratio of men to women of 1:0.7%)). Each patient tested positive for SARS-CoV-2. Death was mainly the result of respiratory failure. The second most common cause of death was acute heart failure. Few patients specifically died of myocarditis. Variables such as pathological findings, immunohistochemical data, and previous clinical assessments were analyzed. Main cardiac pathological findings were cardiac dilatation, necrosis, lymphocytic infiltration of the myocardium, and small coronary vessel microthrombosis. Immunohistochemical analyses revealed an inflammatory state dominated by the constant presence of CD3+ and CD8+ cytotoxic lymphocytes and CD68+ macrophages. COVID-19 leads to a systemic inflammatory response and a constant prothrombotic state. The results of our systematic review suggest that SARS-CoV-2 was able to cause irreversible changes in several organs, including the heart; this is reflected by the increased cardiac risk in patients who survive COVID-19. Postmortem analysis (including autopsy, histologic, and immunohistochemical examination) is an indispensable tool to better understand pathological changes caused by emerging diseases such as COVID-19. Our results may provide more information on the involvement of the heart in COVID-19 patients.
Highlights
Coronaviruses have always coexisted with humans; in 2020, a new severe acute respiratory syndrome coronavirus (SARS-CoV) developed and caused a worldwide pandemic, as the World Health Organization (WHO) declared in March 2020 [1]
The aim of the present study was to evaluate the current knowledge about postmortem cardiac findings in patients who died of COVID-19 and to provide a systematic review of existing literature
Autopsy Data In November 2020, Lindler et al, published a cohort study of 39 patients who died of COVID-19–related acute respiratory distress syndrome (ARDS) [15]
Summary
Coronaviruses have always coexisted with humans; in 2020, a new severe acute respiratory syndrome coronavirus (SARS-CoV) developed and caused a worldwide pandemic, as the World Health Organization (WHO) declared in March 2020 [1]. SARSCoV-2 caused a new infectious disease called coronavirus disease 2019 (COVID-19). SARSCoV-2 is an ssRNA virus belonging to the family of Coronaviridae. The most important one, the spike protein, is functionally divided into the S1 and S2 domain; the first domain is crucial for the binding of angiotensin-converting enzyme II (ACE2) on the endothelial cells of the lung. The S2 domain is important for cell membrane fusion [4]. The main feature of SARS-CoV-2 is its high airborne transmission capability [5]
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