1. COVID-19–Associated cardiac pathology at the postmortem evaluation: a collaborative systematic review
- Author
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Raghed Almamlouk, Tarek Kashour, Sawsan Obeidat, Melanie C. Bois, Joseph J. Maleszewski, Osama A. Omrani, Rana Tleyjeh, Elie Berbari, Zaher Chakhachiro, Bassel Zein-Sabatto, Dana Gerberi, Imad M. Tleyjeh, Alberto E. Paniz Mondolfi, Aloke V. Finn, Amaro Nunes Duarte-Neto, Amy V. Rapkiewicz, Andrea Frustaci, Arthur-Atilla Keresztesi, Brian Hanley, Bruno Märkl, Christelle Lardi, Clare Bryce, Diana Lindner, Diego Aguiar, Dirk Westermann, Edana Stroberg, Eric J. Duval, Esther Youd, Gaetano Pietro Bulfamante, Isabelle Salmon, Johann Auer, Klaus Hirschbühl, Lara Absil, Lisa M. Barton, Luiz Fernando Ferraz da Silva, Luiza Moore, Marisa Dolhnikoff, Martin Lammens, Michael Osborn, Myriam Remmelink, Paulo Hilario Nascimento Saldiva, Philippe G. Jorens, Randall Craver, Renata Aparecida de Almeida Monteiro, Roberto Scendoni, Sanjay Mukhopadhyay, Tadaki Suzuki, Thais Mauad, Tony Fracasso, Zachary Grimes, and Cardiac Autopsy COVID-19 Study Grp
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Microbiology (medical) ,Myocarditis ,Infectious Diseases ,SARS-CoV-2 ,COVID-19 ,Humans ,Human medicine ,Autopsy ,General Medicine ,Biology ,Lung ,Aged - Abstract
Background: Many postmortem studies address the cardiovascular effects of COVID-19 and provide valuable information, but are limited by their small sample size. Objectives: The aim of this systematic review is to better understand the various aspects of the cardio-vascular complications of COVID-19 by pooling data from a large number of autopsy studies. Data sources: We searched the online databases Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science for concepts of autopsy or histopathology combined with COVID-19, published be-tween database inception and February 2021. We also searched for unpublished manuscripts using the medRxiv services operated by Cold Spring Harbor Laboratory. Study eligibility criteria: Articles were considered eligible for inclusion if they reported human post-mortem cardiovascular findings among individuals with a confirmed SARS coronavirus type 2 (CoV-2) infection. Participants: Confirmed COVID-19 patients with post-mortem cardiovascular findings. Interventions: None. Methods: Studies were individually assessed for risk of selection, detection, and reporting biases. The median prevalence of different autopsy findings with associated interquartile ranges (IQRs). Results: This review cohort contained 50 studies including 548 hearts. The median age of the deceased was 69 years. The most prevalent acute cardiovascular findings were myocardial necrosis (median: 100.0%; IQR, 20%-10 0%; number of studies = 9; number of patients = 64) and myocardial oedema (median: 55.5%; IQR, 19.5%-92.5%; number of studies = 4; number of patients = 46). The median re-ported prevalence of extensive, focal active, and multifocal myocarditis were all 0.0%. The most prevalent chronic changes were myocyte hypertrophy (median: 69.0%; IQR, 46.8%-92.1%) and fibrosis (median: 35.0%; IQR, 35.0%-90.5%). SARS-CoV-2 was detected in the myocardium with median prevalence of 60.8% (IQR 40.4-95.6%). Conclusions: Our systematic review confirmed the high prevalence of acute and chronic cardiac pathologies in COVID-19 and SARS-CoV-2 cardiac tropism, as well as the low prevalence of myocarditis in COVID-19. (C) 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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- 2022