Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic Review
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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-09-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/11/9/1647 |
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| author | Aniello Maiese Paola Frati Fabio Del Duca Paola Santoro Alice Chiara Manetti Raffaele La Russa Marco Di Paolo Emanuela Turillazzi Vittorio Fineschi |
| author_facet | Aniello Maiese Paola Frati Fabio Del Duca Paola Santoro Alice Chiara Manetti Raffaele La Russa Marco Di Paolo Emanuela Turillazzi Vittorio Fineschi |
| author_sort | Aniello Maiese |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T07:45:53Z |
| format | Article |
| id | doaj.art-d3dba62c9c06479984a166dab489f9de |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T07:45:53Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-d3dba62c9c06479984a166dab489f9de2023-11-22T12:40:14ZengMDPI AGDiagnostics2075-44182021-09-01119164710.3390/diagnostics11091647Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic ReviewAniello Maiese0Paola Frati1Fabio Del Duca2Paola Santoro3Alice Chiara Manetti4Raffaele La Russa5Marco Di Paolo6Emanuela Turillazzi7Vittorio Fineschi8Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, ItalyIRCSS Neuromed Mediterranean Neurological Institute, 86077 Pozzilli, ItalyDepartment of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, ItalyDepartment of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, ItalyDepartment of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, ItalyIRCSS Neuromed Mediterranean Neurological Institute, 86077 Pozzilli, ItalyDepartment of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, ItalyDepartment of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, ItalyIRCSS Neuromed Mediterranean Neurological Institute, 86077 Pozzilli, ItalyCoronavirus 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.https://www.mdpi.com/2075-4418/11/9/1647COVID-19SARS-CoV-2postmortemautopsyheartheart failure |
| spellingShingle | Aniello Maiese Paola Frati Fabio Del Duca Paola Santoro Alice Chiara Manetti Raffaele La Russa Marco Di Paolo Emanuela Turillazzi Vittorio Fineschi Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic Review Diagnostics COVID-19 SARS-CoV-2 postmortem autopsy heart heart failure |
| title | Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic Review |
| title_full | Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic Review |
| title_fullStr | Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic Review |
| title_full_unstemmed | Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic Review |
| title_short | Myocardial Pathology in COVID-19-Associated Cardiac Injury: A Systematic Review |
| title_sort | myocardial pathology in covid 19 associated cardiac injury a systematic review |
| topic | COVID-19 SARS-CoV-2 postmortem autopsy heart heart failure |
| url | https://www.mdpi.com/2075-4418/11/9/1647 |
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