Detection of viral SARS-CoV-2 genomes and histopathological changes in endomyocardial biopsies
Detection of viral SARS-CoV-2 genomes and histopathological changes in endomyocardial biopsies
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DOI：
10.1002/ehf2.12805
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发表时间：
2020-06-12
影响因子：
3.8
通讯作者：
Schultheiss, Heinz-Peter
中科院分区：
文献类型：
--
作者：
Escher, Felicitas;Pietsch, Heiko;Schultheiss, Heinz-Peter
自2019年12月以来，新型冠状病毒SARS-CoV-2在中国迅速蔓延，并使世界保持悬念。已报告了COVID-19导致的心血管并发症，包括心肌炎和栓塞。SARS-CoV-2基因组检测在心肌尚未被证明到目前为止，和潜在的病理生理机制仍有待investigated.Methods和结果心肌内膜活检（EMBs）的104例（平均年龄：57.90 +/- 16.37岁，左心室射血分数：33.7 +/-14.6%，性别：n = 79男/25女）与疑似心肌炎或不明原因的心力衰竭进行了分析。EMB分析包括组织学、免疫组织化学和在德国柏林IKDT通过实时逆转录聚合酶链反应检测SARS-CoV-2基因组。在调查的104个EMB中，通过逆转录实时聚合酶链反应（RT-PCR）证实了5个感染了SARS-CoV-2。我们描述了不同的症状和持续时间的患者的历史。此外，我们研究了心肌组织的组织病理学变化，表明EMBs的炎症过程似乎渗透到血管壁，导致小动脉闭塞和damage.Conclusions这是第一个报告，建立了证据的SARS-CoV-2基因组检测EMBs。在这些患者中，心肌损伤缺血可能起作用，这可以解释普遍存在的肌钙蛋白升高。基于EMB的心肌损伤原因的识别可能有助于解释复杂的SARS-CoV-2感染的不同演变，并设计未来的具体和个性化的治疗策略。
Aims Since December 2019, the novel coronavirus SARS-CoV-2 has spread rapidly throughout China and keeps the world in suspense. Cardiovascular complications with myocarditis and embolism due to COVID-19 have been reported. SARS-CoV-2 genome detection in the heart muscle has not been demonstrated so far, and the underlying pathophysiological mechanisms remain to be investigated.Methods and results Endomyocardial biopsies (EMBs) of 104 patients (mean age: 57.90 +/- 16.37 years; left ventricular ejection fraction: 33.7 +/- 14.6%, sex:n = 79 male/25 female) with suspected myocarditis or unexplained heart failure were analysed. EMB analysis included histology, immunohistochemistry, and detection of SARS-CoV-2 genomes by real-time reverse transcription polymerase chain reaction in the IKDT Berlin, Germany. Among 104 EMBs investigated, five were confirmed with SARS-CoV-2 infected by reverse real-time transcriptase polymerase chain reaction. We describe patients of different history of symptoms and time duration. Additionally, we investigated histopathological changes in myocardial tissue showing that the inflammatory process in EMBs seemed to permeate vascular wall leading to small arterial obliteration and damage.Conclusions This is the first report that established the evidence of SARS-CoV-2 genomes detection in EMBs. In these patients, myocardial injury ischaemia may play a role, which could explain the ubiquitous troponin increases. EMB-based identification of the cause of myocardial injury may contribute to explain the different evolution of complicated SARS-CoV-2-infection and to design future specific and personalized treatment strategies.