Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is commonly associated with myocardial injury and heart failure. The pathophysiology behind this phenomenon remains unclear, with many diverse and multifaceted hypotheses. To contribute to this understanding, we describe the underlying cardiac findings in fifty patients who died with coronavirus disease 2019 (COVID-19).

Methods

Included were autopsies performed on patients with a positive SARS-CoV-2 reverse-transcriptase-polymerase-chain reaction test from the index hospitalization. In the case of out-of-hospital death, patients were included if post-mortem testing was positive. Complete autopsies were performed according to a COVID-19 safety protocol, and all patients underwent both macroscopic and microscopic examination. If available, laboratory findings and echocardiograms were reported.

Results

The median age of the decedents was 63.5 years. The most common comorbidities included hypertension (90.0%), diabetes (56.0%) and obesity (50.0%). Lymphocytic inflammatory infiltrates in the heart were present in eight (16.0%) patients, with focal myocarditis present in two (4.0%) patients. Acute myocardial ischemia was observed in eight (16.0%) patients. The most common findings were myocardial fibrosis (80.0%), hypertrophy (72.0%), and microthrombi (66.0%). The most common causes of death were COVID-19 pneumonia in 18 (36.0%), COVID-19 pneumonia with bacterial superinfection in 12 (24.0%), and COVID-19 pneumonia with pulmonary embolism in 10 (20.0%) patients.

Conclusions

Cardiovascular comorbidities were prevalent, and pathologic changes associated with hypertensive and atherosclerotic cardiovascular disease were the most common findings. Despite markedly elevated inflammatory markers and cardiac enzymes, few patients exhibited inflammatory infiltrates or necrosis within cardiac myocytes. A unifying pathophysiologic mechanism behind myocardial injury in COVID-19 remains elusive, and additional autopsy studies are needed.

中文翻译：

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COVID-19 中的心脏病理学：单中心尸检经验

背景

严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 通常与心肌损伤和心力衰竭有关。这种现象背后的病理生理学尚不清楚，有许多不同的和多方面的假设。为了促进这种理解，我们描述了 50 名死于 2019 年冠状病毒病 (COVID-19) 的患者的潜在心脏发现。

方法

包括对指数住院期间 SARS-CoV-2 逆转录酶聚合酶链反应检测呈阳性的患者进行尸检。在院外死亡的情况下，如果验尸结果呈阳性，则包括患者。根据 COVID-19 安全协议进行了完整的尸检，所有患者均接受了肉眼和显微镜检查。如果可用，报告实验室检查结果和超声心动图。

结果

死者的中位年龄为 63.5 岁。最常见的合并症包括高血压 (90.0%)、糖尿病 (56.0%) 和肥胖症 (50.0%)。8 名 (16.0%) 患者出现心脏淋巴细胞炎症浸润，2 名 (4.0%) 患者出现局灶性心肌炎。在 8 名 (16.0%) 患者中观察到急性心肌缺血。最常见的发现是心肌纤维化 (80.0%)、肥厚 (72.0%) 和微血栓 (66.0%)。最常见的死亡原因是 18 名 (36.0%) 的 COVID-19 肺炎、12 名 (24.0%) 的 COVID-19 肺炎合并细菌双重感染和 10 名 (20.0%) 名患者的 COVID-19 肺炎合并肺栓塞。

结论

心血管合并症很普遍，与高血压和动脉粥样硬化性心血管疾病相关的病理变化是最常见的发现。尽管炎症标志物和心肌酶显着升高，但很少有患者在心肌细胞内表现出炎症浸润或坏死。COVID-19 心肌损伤背后的统一病理生理机制仍然难以捉摸，需要额外的尸检研究。