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Characterisation of cardiac pathology in 23 autopsies of lethal COVID-19.
Haslbauer, Jasmin D; Tzankov, Alexandar; Mertz, Kirsten D; Schwab, Nathalie; Nienhold, Ronny; Twerenbold, Raphael; Leibundgut, Gregor; Stalder, Anna K; Matter, Matthias; Glatz, Katharina.
  • Haslbauer JD; Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Tzankov A; Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Mertz KD; Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland.
  • Schwab N; Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland.
  • Nienhold R; Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland.
  • Twerenbold R; Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Leibundgut G; Cardiology, Cantonal Hospital Baselland, Liestal, Switzerland.
  • Stalder AK; Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Matter M; Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Glatz K; Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
J Pathol Clin Res ; 7(4): 326-337, 2021 07.
Article in English | MEDLINE | ID: covidwho-1173791
ABSTRACT
While coronavirus disease 2019 (COVID-19) primarily affects the respiratory tract, pathophysiological changes of the cardiovascular system remain to be elucidated. We performed a retrospective cardiopathological analysis of the heart and vasculature from 23 autopsies of COVID-19 patients, comparing the findings with control tissue. Myocardium from autopsies of COVID-19 patients was categorised into severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive (n = 14) or negative (n = 9) based on the presence of viral RNA as determined by reverse transcriptase polymerase chain reaction (RT-PCR). Control tissue was selected from autopsies without COVID-19 (n = 10) with similar clinical sequelae. Histological characteristics were scored by ordinal and/or categorical grading. Five RT-PCR-positive cases underwent in situ hybridisation (ISH) for SARS-CoV-2. Patients with lethal COVID-19 infection were mostly male (78%) and had a high incidence of hypertension (91%), coronary artery disease (61%), and diabetes mellitus (48%). Patients with positive myocardial RT-PCR died earlier after hospital admission (5 versus 12 days, p < 0.001) than patients with negative RT-PCR. An increased severity of fibrin deposition, capillary dilatation, and microhaemorrhage was observed in RT-PCR-positive myocardium than in negatives and controls, with a positive correlation amongst these factors All cases with increased cardioinflammatory infiltrate, without myocyte necrosis (n = 4) or with myocarditis (n = 1), were RT-PCR negative. ISH revealed positivity of viral RNA in interstitial cells. Myocardial capillary dilatation, fibrin deposition, and microhaemorrhage may be the histomorphological correlate of COVID-19-associated coagulopathy. Increased cardioinflammation including one case of myocarditis was only detected in RT-PCR-negative hearts with significantly longer hospitalisation time. This may imply a secondary immunological response warranting further characterisation.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory System / SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Pathol Clin Res Year: 2021 Document Type: Article Affiliation country: Cjp2.212

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory System / SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Pathol Clin Res Year: 2021 Document Type: Article Affiliation country: Cjp2.212