TY - JOUR
T1 - COVID-19–Associated cardiac pathology at the postmortem evaluation
T2 - a collaborative systematic review
AU - the Cardiac Autopsy in COVID-19 Study Group
AU - Almamlouk, Raghed
AU - Kashour, Tarek
AU - Obeidat, Sawsan
AU - Bois, Melanie C.
AU - Maleszewski, Joseph J.
AU - Omrani, Osama A.
AU - Tleyjeh, Rana
AU - Berbari, Elie
AU - Chakhachiro, Zaher
AU - Zein-Sabatto, Bassel
AU - Gerberi, Dana
AU - Tleyjeh, Imad M.
AU - Paniz Mondolfi, Alberto E.
AU - Finn, Aloke V.
AU - Duarte-Neto, Amaro Nunes
AU - Rapkiewicz, Amy V.
AU - Frustaci, Andrea
AU - Keresztesi, Arthur Atilla
AU - Hanley, Brian
AU - Märkl, Bruno
AU - Lardi, Christelle
AU - Bryce, Clare
AU - Lindner, Diana
AU - Aguiar, Diego
AU - Westermann, Dirk
AU - Stroberg, Edana
AU - Duval, Eric J.
AU - Youd, Esther
AU - Bulfamante, Gaetano Pietro
AU - Salmon, Isabelle
AU - Auer, Johann
AU - Hirschbühl, Klaus
AU - Absil, Lara
AU - Barton, Lisa M.
AU - Ferraz da Silva, Luiz Fernando
AU - Moore, Luiza
AU - Dolhnikoff, Marisa
AU - Lammens, Martin
AU - Osborn, Michael
AU - Remmelink, Myriam
AU - Nascimento Saldiva, Paulo Hilario
AU - Jorens, Philippe G.
AU - Craver, Randall
AU - Aparecida de Almeida Monteiro, Renata
AU - Scendoni, Roberto
AU - Mukhopadhyay, Sanjay
AU - Suzuki, Tadaki
AU - Mauad, Thais
AU - Fracasso, Tony
AU - Grimes, Zachary
N1 - Publisher Copyright:
© 2022 European Society of Clinical Microbiology and Infectious Diseases
PY - 2022/8
Y1 - 2022/8
N2 - 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 cardiovascular 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 between 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 We also searched for unpublished manuscripts using the medRxiv services operated by Cold Spring Harbor Laboratory.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 postmortem 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%–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%). 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.
AB - 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 cardiovascular 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 between 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 postmortem 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%–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%). 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.
KW - COVID-19
KW - Cardiac pathology
KW - Myocarditis
KW - Postmortem
KW - SARS-CoV-2
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85130359402&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130359402&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2022.03.021
DO - 10.1016/j.cmi.2022.03.021
M3 - Review article
C2 - 35339672
AN - SCOPUS:85130359402
SN - 1198-743X
VL - 28
SP - 1066
EP - 1075
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 8
ER -