Oprinca George-Călin, Oprinca-Muja Lilioara-Alexandra, Mihalache Manuela, Birlutiu Rares-Mircea, Birlutiu Victoria
Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania.
FOISOR Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular, 030167 Bucharest, Romania.
Microorganisms. 2022 Jun 21;10(7):1258. doi: 10.3390/microorganisms10071258.
Myocardial injury in patients with SARS-CoV-2 infection may be attributed to the presence of the virus at the cellular level, however, it may also be secondary to other diseases, playing an essential role in the evolution of the disease. We evaluated 16 patients who died because of SARS-CoV-2 infection and analyzed the group from both clinical and pathological points of view. All autopsies were conducted in the Sibiu County morgue, taking into consideration all the national protocols for COVID-19 patients. Of the 16 autopsies we performed, two were complete, including an extensive examination of the cranial cavity. In our study, the cardiac injury was primarily cumulative. Chronic cardiac injuries included fatty infiltration of the myocardium in five cases, fibrosis in 11 cases, and coronary atherosclerosis in two cases. Among the cases with evidence of acute cardiovascular injuries, inflammatory lymphocytic infiltrate was observed in nine cases, subepicardial or visceral pericardial neutrophil-rich vascular congestion in five cases, and venous thrombosis in three cases. Acute ischemia or myocytic distress was identified by vacuolar degeneration in four cases; areas of undulated and/or fragmented myocardial fibers, with eosinophilia and nuclear pyknosis with or without enucleation of the myocytes in nine cases; and in one case, we observed a large area of myocardial necrosis. Immunohistochemical criteria confirmed the presence of the SARS-CoV-2 antigen at the level of the myocardium in only two cases. Comorbidities existing prior to SARS-CoV-2 infection associated with systemic and local inflammatory, thrombotic, hypoxic, or immunological phenomena influence the development of cardiac lesions, leading to death.
新型冠状病毒肺炎（SARS-CoV-2）感染患者的心肌损伤可能归因于病毒在细胞水平的存在，然而，它也可能继发于其他疾病，在疾病演变中起重要作用。我们评估了16例因新型冠状病毒肺炎（SARS-CoV-2）感染死亡的患者，并从临床和病理角度对该组患者进行了分析。所有尸检均在锡比乌县太平间进行，遵循了所有针对COVID-19患者的国家协议。在我们进行的16例尸检中，2例完整，包括对颅腔的广泛检查。在我们的研究中，心脏损伤主要是累积性的。慢性心脏损伤包括5例心肌脂肪浸润、11例纤维化和2例冠状动脉粥样硬化。在有急性心血管损伤证据的病例中，9例观察到炎性淋巴细胞浸润，5例观察到心外膜下或脏层心包富含中性粒细胞的血管充血，3例观察到静脉血栓形成。4例通过空泡变性确定为急性缺血或心肌细胞窘迫；9例观察到心肌纤维呈波浪状和/或断裂区域，伴有嗜酸性粒细胞增多和核固缩，部分心肌细胞有或无细胞核脱出；1例观察到大面积心肌坏死。免疫组织化学标准仅在2例心肌中证实存在新型冠状病毒肺炎（SARS-CoV-2）抗原。新型冠状病毒肺炎（SARS-CoV-2）感染之前存在的合并症与全身和局部炎症、血栓形成、缺氧或免疫现象相关，影响心脏病变的发展，导致死亡。
