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

Authors
  • Halushka, Marc K.1
  • Vander Heide, Richard S.2
  • 1 Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD
  • 2 Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA
Type
Published Article
Journal
Cardiovascular Pathology
Publisher
Elsevier Inc.
Publication Date
Oct 23, 2020
Volume
50
Pages
107300–107300
Identifiers
DOI: 10.1016/j.carpath.2020.107300
PMID: 33132119
PMCID: PMC7583586
Source
PubMed Central
Keywords
License
Unknown

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.

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