To investigate whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)–induced myocarditis constitutes an important mechanism of cardiac injury, a review was conducted of the published data and the authors’ experience was added from autopsy examination of 16 patients dying of SARS-CoV-2 infection. Myocarditis is an uncommon pathologic diagnosis occurring in 4.5% of highly selected cases undergoing autopsy or endomyocardial biopsy. Although polymerase chain reaction–detectable virus could be found in the lungs of most coronavirus disease-2019 (COVID-19)–infected subjects in our own autopsy registry, in only 2 cases was the virus detected in the heart. It should be appreciated that myocardial inflammation alone by macrophages and T cells can be seen in noninfectious deaths and COVID-19 cases, but the extent of each is different, and in neither case do such findings represent clinically relevant myocarditis. Given its extremely low frequency and unclear therapeutic implications, the authors do not advocate use of endomyocardial biopsy to diagnose myocarditis in the setting of COVID-19.

中文翻译：

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SARS-CoV-2 引起心肌炎的病理学证据

为了研究严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 诱发的心肌炎是否构成心脏损伤的重要机制，对已发表的数据进行了审查，并从对 16 名患者的尸检检查中加入了作者的经验死于 SARS-CoV-2 感染。心肌炎是一种罕见的病理诊断，发生在 4.5% 的经过尸检或心内膜心肌活检的高度选择病例中。尽管在我们自己的尸检登记中，大多数冠状病毒病 2019 (COVID-19) 感染受试者的肺部都可以发现聚合酶链反应可检测的病毒，但只有 2 例在心脏中检测到病毒。应该理解的是，在非感染性死亡和 COVID-19 病例中可以看到仅由巨噬细胞和 T 细胞引起的心肌炎症，但各自的程度不同，在这两种情况下，这些发现都不能代表临床相关的心肌炎。鉴于其极低的频率和不明确的治疗意义，作者不主张在 COVID-19 的情况下使用心内膜心肌活检来诊断心肌炎。