Faculty Collaboration Database

Factors associated with myocardial SARS-CoV-2 infection, myocarditis, and cardiac inflammation in patients with COVID-19. Mod Pathol 2021 Jul;34(7):1345-1357

Date

03/18/2021

Pubmed ID

33727695

Pubmed Central ID

PMC9813560

DOI

10.1038/s41379-021-00790-1

Scopus ID

2-s2.0-85102868141 (requires institutional sign-in at Scopus site)   76 Citations

Abstract

COVID-19 has been associated with cardiac injury and dysfunction. While both myocardial inflammatory cell infiltration and myocarditis with myocyte injury have been reported in patients with fatal COVID-19, clinical-pathologic correlations remain limited. The objective was to determine the relationships between cardiac pathological changes in patients dying from COVID-19 and cardiac infection by SARS-CoV-2, laboratory measurements, clinical features, and treatments. In a retrospective study, 41 consecutive autopsies of patients with fatal COVID-19 were analyzed for the associations between cardiac inflammation, myocarditis, cardiac infection by SARS-CoV-2, clinical features, laboratory measurements, and treatments. Cardiac infection was assessed by in situ hybridization and NanoString transcriptomic profiling. Cardiac infection by SARS-CoV-2 was present in 30/41 cases: virus⁺ with myocarditis (n = 4), virus⁺ without myocarditis (n = 26), and virus^- without myocarditis (n = 11). In the cases with cardiac infection, SARS-CoV-2⁺ cells in the myocardium were rare, with a median density of 1 cell/cm². Virus⁺ cases showed higher densities of myocardial CD68⁺ macrophages and CD3⁺ lymphocytes, as well as more electrocardiographic changes (23/27 vs 4/10; P = 0.01). Myocarditis was more prevalent with IL-6 blockade than with nonbiologic immunosuppression, primarily glucocorticoids (2/3 vs 0/14; P = 0.02). Overall, SARS-CoV-2 cardiac infection was less prevalent in patients treated with nonbiologic immunosuppression (7/14 vs 21/24; P = 0.02). Myocardial macrophage and lymphocyte densities overall were positively correlated with the duration of symptoms but not with underlying comorbidities. In summary, cardiac infection with SARS-CoV-2 is common among patients dying from COVID-19 but often with only rare infected cells. Cardiac infection by SARS-CoV-2 is associated with more cardiac inflammation and electrocardiographic changes. Nonbiologic immunosuppression is associated with lower incidences of myocarditis and cardiac infection by SARS-CoV-2.

Author List

Bearse M, Hung YP, Krauson AJ, Bonanno L, Boyraz B, Harris CK, Helland TL, Hilburn CF, Hutchison B, Jobbagy S, Marshall MS, Shepherd DJ, Villalba JA, Delfino I, Mendez-Pena J, Chebib I, Newton-Cheh C, Stone JR

Author

Bailey Hutchison MD Assistant Professor in the Pathology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anticoagulants
Autopsy
Echocardiography
Electrocardiography
Female
Humans
Immunosuppressive Agents
Male
Myocarditis
Myocardium
Retrospective Studies