Microthrombi as a Major Cause of Cardiac Injury in COVID-19 A Pathologic Study
Microthrombi as a Major Cause of Cardiac Injury in COVID-19 A Pathologic Study
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DOI：
10.1161/circulationaha.120.051828
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发表时间：
2021-03-09
期刊：
影响因子：
37.8
通讯作者：
Finn, Aloke V.
中科院分区：
文献类型：
--
作者：
Pellegrini, Dario;Kawakami, Rika;Finn, Aloke V.
背景：心脏损伤在因2019冠状病毒病（COVID-19）住院的患者中很常见，预示着预后较差。然而，严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）相关的心肌损伤的机制和类型仍不确定。方法：我们对意大利贝加莫因COVID-19死亡的40例住院患者的心脏进行了系统的病理分析，以确定心脏损伤的病理机制。我们划分的心脏根据存在或不存在急性心肌细胞坏死，然后确定的潜在mechanisms of cardiac injury.Results：在40心脏检查，14（35%）有心肌细胞坏死的证据，主要是左心室。与无坏死的受试者相比，坏死受试者倾向于女性，患有慢性肾脏疾病，症状发作至入院时间较短。严重冠状动脉疾病（即>75%的横截面狭窄）的发生率在有和没有坏死的患者之间没有显著差异。3/14例（21.4%）心肌细胞坏死的受试者显示急性心肌梗死的证据，定义为坏死面积>= 1 cm（2），而11/14例（78.6%）显示局灶性证据（>20个坏死心肌细胞，面积>= 0.05 mm（2），
Background:Cardiac injury is common in patients who are hospitalized with coronavirus disease 2019 (COVID-19) and portends poorer prognosis. However, the mechanism and the type of myocardial damage associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain uncertain.Methods:We conducted a systematic pathological analysis of 40 hearts from hospitalized patients dying of COVID-19 in Bergamo, Italy, to determine the pathological mechanisms of cardiac injury. We divided the hearts according to presence or absence of acute myocyte necrosis and then determined the underlying mechanisms of cardiac injury.Results:Of the 40 hearts examined, 14 (35%) had evidence of myocyte necrosis, predominantly of the left ventricle. Compared with subjects without necrosis, subjects with necrosis tended to be female, have chronic kidney disease, and have shorter symptom onset to admission. The incidence of severe coronary artery disease (ie, >75% cross-sectional narrowing) was not significantly different between those with and without necrosis. Three of 14 (21.4%) subjects with myocyte necrosis showed evidence of acute myocardial infarction, defined as >= 1 cm(2) area of necrosis, whereas 11 of 14 (78.6%) showed evidence of focal (>20 necrotic myocytes with an area of >= 0.05 mm(2) but