Factors associated with myocardial SARS-CoV-2 infection, myocarditis, and cardiac inflammation in patients with COVID-19.
Factors associated with myocardial SARS-CoV-2 infection, myocarditis, and cardiac inflammation in patients with COVID-19.
复制标题
DOI：
10.1038/s41379-021-00790-1
复制
发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Stone JR
中科院分区：
文献类型：
--
作者：
Bearse M;Hung YP;Krauson AJ;Bonanno L;Boyraz B;Harris CK;Helland TL;Hilburn CF;Hutchison B;Jobbagy S;Marshall MS;Shepherd DJ;Villalba JA;Delfino I;Mendez-Pena J;Chebib I;Newton-Cheh C;Stone JR
COVID-19与心脏损伤和功能障碍有关。虽然在致命性COVID-19患者中报告了心肌炎性细胞浸润和心肌炎伴心肌细胞损伤，但临床病理相关性仍然有限。目的是确定死于COVID-19的患者的心脏病理变化与SARS-CoV-2心脏感染、实验室测量、临床特征和治疗之间的关系。在一项回顾性研究中，分析了41例致死性COVID-19患者的连续尸检，以了解心脏炎症、心肌炎、SARS-CoV-2心脏感染、临床特征、实验室测量和治疗之间的关系。通过原位杂交和NanoString转录组学分析评估心脏感染。41例病例中有30例存在SARS-CoV-2引起的心脏感染：病毒+伴心肌炎（n = 4），病毒+不伴心肌炎（n = 26），病毒-不伴心肌炎（n = 11）。在心脏感染的病例中，心肌中SARS-CoV-2+细胞很少，中位密度为1个细胞/cm 2。病毒阳性组心肌CD 68+巨噬细胞和CD 3+淋巴细胞密度较高，心电图改变较多（23/27 vs 4/10; P = 0.01）。使用IL-6阻断剂的心肌炎发生率高于使用非生物免疫抑制剂（主要是糖皮质激素）的心肌炎发生率（2/3 vs 0/14; P = 0.02）。总的来说，SARS-CoV-2心脏感染在接受非生物免疫抑制治疗的患者中发病率较低（7/14 vs 21/24; P = 0.02）。心肌巨噬细胞和淋巴细胞密度总体上与症状持续时间呈正相关，但与基础合并症无关。总之，心脏感染SARS-CoV-2在死于COVID-19的患者中很常见，但通常只有罕见的感染细胞。SARS-CoV-2引起的心脏感染与更多的心脏炎症和心电图改变相关。非生物免疫抑制与SARS-CoV-2引起的心肌炎和心脏感染的发生率较低相关。
COVID-19 has been associated with cardiac injury and dysfunction. While both myocardial inflammatory cell infiltration and myocarditis with myocyte injury have been reported in patients with fatal COVID-19, clinical–pathologic correlations remain limited. The objective was to determine the relationships between cardiac pathological changes in patients dying from COVID-19 and cardiac infection by SARS-CoV-2, laboratory measurements, clinical features, and treatments. In a retrospective study, 41 consecutive autopsies of patients with fatal COVID-19 were analyzed for the associations between cardiac inflammation, myocarditis, cardiac infection by SARS-CoV-2, clinical features, laboratory measurements, and treatments. Cardiac infection was assessed by in situ hybridization and NanoString transcriptomic profiling. Cardiac infection by SARS-CoV-2 was present in 30/41 cases: virus+ with myocarditis (n = 4), virus+ without myocarditis (n = 26), and virus– without myocarditis (n = 11). In the cases with cardiac infection, SARS-CoV-2+ cells in the myocardium were rare, with a median density of 1 cell/cm2. Virus+ cases showed higher densities of myocardial CD68+ macrophages and CD3+ lymphocytes, as well as more electrocardiographic changes (23/27 vs 4/10; P = 0.01). Myocarditis was more prevalent with IL-6 blockade than with nonbiologic immunosuppression, primarily glucocorticoids (2/3 vs 0/14; P = 0.02). Overall, SARS-CoV-2 cardiac infection was less prevalent in patients treated with nonbiologic immunosuppression (7/14 vs 21/24; P = 0.02). Myocardial macrophage and lymphocyte densities overall were positively correlated with the duration of symptoms but not with underlying comorbidities. In summary, cardiac infection with SARS-CoV-2 is common among patients dying from COVID-19 but often with only rare infected cells. Cardiac infection by SARS-CoV-2 is associated with more cardiac inflammation and electrocardiographic changes. Nonbiologic immunosuppression is associated with lower incidences of myocarditis and cardiac infection by SARS-CoV-2.
登录
查看更多内容
影响因子：
3.7
作者：
Li, Yu;Stone, James R.
通讯作者：
Stone, James R.
影响因子：
3.7
作者：
Bassett IV;Triant VA;Bunda BA;Selvaggi CA;Shinnick DJ;He W;Lu F;Porneala BC;Cao T;Lubitz SA;Meigs JB;Hsu J;Foulkes AS
通讯作者：
Foulkes AS
影响因子：
7.5
作者：
Champion, Samantha N.;Stone, James R.
通讯作者：
Stone, James R.
影响因子：
24
作者：
Giustino G;Croft LB;Stefanini GG;Bragato R;Silbiger JJ;Vicenzi M;Danilov T;Kukar N;Shaban N;Kini A;Camaj A;Bienstock SW;Rashed ER;Rahman K;Oates CP;Buckley S;Elbaum LS;Arkonac D;Fiter R;Singh R;Li E;Razuk V;Robinson SE;Miller M;Bier B;Donghi V;Pisaniello M;Mantovani R;Pinto G;Rota I;Baggio S;Chiarito M;Fazzari F;Cusmano I;Curzi M;Ro R;Malick W;Kamran M;Kohli-Seth R;Bassily-Marcus AM;Neibart E;Serrao G;Perk G;Mancini D;Reddy VY;Pinney SP;Dangas G;Blasi F;Sharma SK;Mehran R;Condorelli G;Stone GW;Fuster V;Lerakis S;Goldman ME
通讯作者：
Goldman ME
影响因子：
39
作者：
Hermine, Olivier;Mariette, Xavier;Ravaud, Philippe
通讯作者：
Ravaud, Philippe