Pathological Evidence for SARS-CoV-2 as a Cause of Myocarditis JACC Review Topic of the Week

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Review

Kawakami, Rika¹  Sakamoto, Atsushi¹  Kawai, Kenji¹  Gianatti, Andrea²  Pellegrini, Dario²  Nasr, Ahmed²  Kutys, Bob¹  Guo, Liang¹  Cornelissen, Anne¹  Mori, Masayuki¹  Sato, Yu¹  Pescetelli, Irene²  Brivio, Matteo²  Romero, Maria¹  Guagliumi, Giulio²  Virmani, Renu¹  Finn, Aloke V.³ 

[1] CVPath Inst Inc, Dept Cardiovasc Pathol, Gaithersburg, MD USA

[2] Osped Papa Giovanni XXIII, Dept Med, Bergamo, Italy

[3] Univ Maryland, Dept Med, Baltimore, MD 21201 USA

关键词: cardiovascular disease;    COVID-19;    heart;    SARS-CoV-2;   

DOI  :  10.1016/j.jacc.2020.11.031

来源: Elsevier

【 摘 要 】

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. (C) 2021 by the American College of Cardiology Foundation.

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