COVID-19 and the Heart: A Systematic Review of Cardiac Autopsies.
COVID-19 and the Heart: A Systematic Review of Cardiac Autopsies.
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DOI：
10.3389/fcvm.2020.626975
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发表时间：
2020
影响因子：
3.6
通讯作者：
Coghlan JG
中科院分区：
文献类型：
--
作者：
Roshdy A;Zaher S;Fayed H;Coghlan JG
重要性：严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关的心脏损伤已被假定继发于几种机制。虽然在急性疾病期间组织诊断是有限的，但死后研究可以帮助我们提高理解和指导管理。目的：报告2019冠状病毒病（COVID-19）死亡者的心脏组织尸检结果。证据审查：发表在PubMed和Embase上的文章报告了截至2020年9月的COVID-19死亡者的死后心脏病理学。我们包括成人研究，不包括预印本。使用乔安娜布里格斯研究所病例报告的关键评估清单评估质量。我们提取了大体和组织学数据以及心肌炎、心肌缺血、血栓形成和扩张的发生率。我们还查看了报告的死亡原因（PROSPERO注册CRD 42020190898）。结果：确定了41项相关研究，包括316例病例。死者大多为男性（62%）和老年人（中位年龄75岁;范围22-97岁）。最常见的合并症是高血压（48%）和冠状动脉疾病（33%）。心脏病导致15例死亡。除慢性心脏病外，尸检显示心脏扩张（20%）、急性缺血（8%）、心内血栓（2.5%）、心包积液（2.5%）和心肌炎（1.5%）。在47%的研究心脏的心肌中检测到SARS-CoV-2。结论和相关性：SARS-CoV-2可以侵入心脏，但少数病例被发现有心肌炎。心脏扩张、缺血、壁和微血栓是最常见的结果。系统评价受到病例数量少和研究质量的限制，需要标准化心脏尸检方案。
Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated cardiac injury has been postulated secondary to several mechanisms. While tissue diagnosis is limited during the acute illness, postmortem studies can help boost our understanding and guide management. Objective: To report the cardiac tissue autopsy findings in coronavirus disease 2019 (COVID-19) decedents. Evidence Review: Articles published in PubMed and Embase reporting postmortem cardiac pathology of COVID-19 decedents till September 2020. We included adult studies excluding preprints. The Joanna Briggs Institute Critical Appraisal Checklist for Case Reports was used to assess quality. We extracted gross and histology data as well as the incidence of myocarditis, cardiac ischemia, thrombosis, and dilatation. We also looked at the reported cause of death (PROSPERO registration CRD42020190898). Findings: Forty-one relevant studies identified including 316 cases. The deceased were mostly male (62%) and elderly (median age, 75; range, 22–97 years). The most common comorbidities were hypertension (48%) and coronary artery disease (33%). Cardiac pathologies contributed to the death of 15 cases. Besides chronic cardiac pathologies, postmortem examination demonstrated cardiac dilatation (20%), acute ischemia (8%), intracardiac thrombi (2.5%), pericardial effusion (2.5%), and myocarditis (1.5%). SARS-CoV-2 was detected within the myocardium of 47% of studied hearts. Conclusions and Relevance: SARS-CoV-2 can invade the heart, but a minority of cases were found to have myocarditis. Cardiac dilatation, ischemia, mural, and microthrombi were the most frequent findings. The systematic review was limited by the small number of cases and the quality of the studies, and there is a need to standardize the cardiac postmortem protocols.
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