Bulfamante Gaetano Pietro, Perrucci Gianluca Lorenzo, Falleni Monica, Sommariva Elena, Tosi Delfina, Martinelli Carla, Songia Paola, Poggio Paolo, Carugo Stefano, Pompilio Giulio
Unità di Anatomia Patologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
Struttura Complessa di Anatomia Patologica e Genetica Medica, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
Biomedicines. 2020 Dec 18;8(12):626. doi: 10.3390/biomedicines8120626.
A considerable proportion of patients affected by coronavirus respiratory disease (COVID-19) develop cardiac injury. The viral impact in cardiomyocytes deserves, however, further investigations, especially in asymptomatic patients.
We investigated for SARS-CoV-2 presence and activity in heart tissues of six consecutive COVID-19 patients deceased from respiratory failure showing no signs of cardiac involvement and with no history of heart disease. Cardiac autopsy samples were collected within 2 h after death, and then analysed by digital PCR, Western blot, immunohistochemistry, immunofluorescence, RNAScope, and transmission electron microscopy assays.
The presence of SARS-CoV-2 into cardiomyocytes was invariably detected in all assays. A variable pattern of cardiomyocyte injury was observed, spanning from absence of cell death and subcellular alterations hallmarks, to intracellular oedema and sarcomere ruptures. In addition, we found active viral transcription in cardiomyocytes, by detecting both sense and antisense SARS-CoV-2 spike RNA.
In this autopsy analysis of patients with no clinical signs of cardiac involvement, the presence of SARS-CoV-2 in cardiomyocytes has been detected, determining variable patterns of intracellular damage. These findings suggest the need for cardiologic surveillance in surviving COVID-19 patients not displaying a cardiac phenotype.
相当一部分感染冠状病毒呼吸道疾病（COVID-19）的患者会出现心脏损伤。然而，病毒对心肌细胞的影响值得进一步研究，尤其是在无症状患者中。
我们调查了6例因呼吸衰竭死亡的COVID-19患者心脏组织中SARS-CoV-2的存在和活性，这些患者无心脏受累迹象且无心脏病史。在死亡后2小时内采集心脏尸检样本，然后通过数字PCR、蛋白质印迹法、免疫组织化学、免疫荧光、RNAscope和透射电子显微镜检测进行分析。
在所有检测中均始终检测到心肌细胞中存在SARS-CoV-2。观察到心肌细胞损伤的模式各不相同，从无细胞死亡和亚细胞改变特征，到细胞内水肿和肌节破裂。此外，通过检测有义链和反义链SARS-CoV-2刺突RNA，我们在心肌细胞中发现了活跃的病毒转录。
在对无心脏受累临床体征患者的本次尸检分析中，已检测到心肌细胞中存在SARS-CoV-2，确定了细胞内损伤的不同模式。这些发现表明，对于未表现出心脏表型的COVID-19存活患者需要进行心脏监测。
