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Pathological Evidence for SARS-CoV-2 as a Cause of Myocarditis

2021; Elsevier BV; Volume: 77; Issue: 3 Linguagem: Inglês

10.1016/j.jacc.2020.11.031

1558-3597

Rika Kawakami, Atsushi Sakamoto, Kenji Kawai, Andrea Gianatti, Dario Pellegrini, Ahmed Nasr, Bob Kutys, Liang Guo, Anne Cornelissen, Masayuki Mori, Yu Sato, Irene Pescetelli, Matteo Brivio, Maria Romero, Giulio Guagliumi, Renu Virmani, Aloke V. Finn,

COVID-19 Clinical Research Studies

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. • Whether myocarditis is a cause of myocardial injury in patients with COVID-19 is uncertain. • Myocarditis is uncommon in autopsy or EMB in cases of COVID-19. • Further work is needed to fully understand the cardiac effects of COVID-19 infection.