Elsevier

Cardiovascular Pathology

Volume 50, January–February 2021, 107300
Cardiovascular Pathology

Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations

https://doi.org/10.1016/j.carpath.2020.107300Get rights and content

Highlights

  • COVID-19 myocarditis has a rate between 1.4% and 7.2% in an autopsy population of 277 subjects.

  • The reporting of many SARS-CoV-2-related histopathologies are skewed between studies.

  • More specific reporting of cardiovascular findings in COVID-19 can be aided by an autopsy checklist.

Abstract

The COVID-19 pandemic, the result of severe acute respiratory syndrome (SARS)-CoV-2, is a major cause of worldwide mortality with a significant cardiovascular component. While a number of different cardiovascular histopathologies have been reported at postmortem examination, their incidence is unknown, due to limited numbers of cases in any given study. A literature review was performed identifying 277 autopsied hearts across 22 separate publications of COVID-19 positive patients. The median age of the autopsy cohort was 75 and 97.6% had one or more comorbidities. Initial review of the data indicate that myocarditis was present in 20 hearts (7.2%); however, closer examination of additional reported information revealed that most cases were likely not functionally significant and the true prevalence of myocarditis is likely much lower (<2%). At least one acute, potentially COVID-19-related cardiovascular histopathologic finding, such as macro or microvascular thrombi, inflammation, or intraluminal megakaryocytes, was reported in 47.8% of cases. Significant differences in reporting of histopathologic findings occurred between studies indicating strong biases in observations and the need for more consistency in reporting. In conclusion, across 277 cases, COVID-19-related cardiac histopathological findings, are common, while myocarditis is rare.

Keywords

COVID-19
SARS-CoV-2
autopsy
myocarditis
heart
inflammation

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