COVID-19–Associated cardiac pathology at the postmortem evaluation: a collaborative systematic review

Many postmortem studies address the cardiovascular effects of COVID-19 and provide valuable information, but are limited by their small sample size. The aim of this systematic review is to better understand the various aspects of the cardiovascular complications of COVID-19 by pooling data from a la...

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Published in:	Clinical microbiology and infection Vol. 28; no. 8; pp. 1066 - 1075
Main Authors:	Almamlouk, Raghed, Kashour, Tarek, Obeidat, Sawsan, Bois, Melanie C., Maleszewski, Joseph J., Omrani, Osama A., Tleyjeh, Rana, Berbari, Elie, Chakhachiro, Zaher, Zein-Sabatto, Bassel, Gerberi, Dana, Tleyjeh, Imad M., Paniz Mondolfi, Alberto E., Finn, Aloke V., Duarte-Neto, Amaro Nunes, Rapkiewicz, Amy V., Frustaci, Andrea, Keresztesi, Arthur-Atilla, Hanley, Brian, Märkl, Bruno, Lardi, Christelle, Bryce, Clare, Lindner, Diana, Aguiar, Diego, Westermann, Dirk, Stroberg, Edana, Duval, Eric J., Youd, Esther, Bulfamante, Gaetano Pietro, Salmon, Isabelle, Auer, Johann, Hirschbühl, Klaus, Absil, Lara, Barton, Lisa M., Ferraz da Silva, Luiz Fernando, Moore, Luiza, Dolhnikoff, Marisa, Lammens, Martin, Osborn, Michael, Remmelink, Myriam, Nascimento Saldiva, Paulo Hilario, Jorens, Philippe G., Craver, Randall, Aparecida de Almeida Monteiro, Renata, Scendoni, Roberto, Mukhopadhyay, Sanjay, Suzuki, Tadaki, Mauad, Thais, Fracasso, Tony, Grimes, Zachary
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-08-2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd
Subjects:	Aged Autopsy Cardiac pathology COVID-19 Humans Lung Myocarditis Myocarditis - epidemiology Postmortem SARS-CoV-2 Systematic Review COVID-19 Myocarditis Cardiac pathology Systematic review SARS-CoV-2 Postmortem
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Summary:	Many postmortem studies address the cardiovascular effects of COVID-19 and provide valuable information, but are limited by their small sample size. The aim of this systematic review is to better understand the various aspects of the cardiovascular complications of COVID-19 by pooling data from a large number of autopsy studies. 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 between database inception and February 2021. We also searched for unpublished manuscripts using the medRxiv services operated by Cold Spring Harbor Laboratory. Articles were considered eligible for inclusion if they reported human postmortem cardiovascular findings among individuals with a confirmed SARS coronavirus type 2 (CoV-2) infection. Confirmed COVID-19 patients with post-mortem cardiovascular findings. None. Studies were individually assessed for risk of selection, detection, and reporting biases. The median prevalence of different autopsy findings with associated interquartile ranges (IQRs). 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%–100%; 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 reported 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%). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 ObjectType-Undefined-4 Raghed Almamlouk, Tarek Kashour, and Sawsan Obeidat contributed equally to this work.
ISSN:	1198-743X 1469-0691 1469-0691
DOI:	10.1016/j.cmi.2022.03.021