COVID Heart Autopsies Point More to Clot Damage Than Myocard
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A careful look at the heart after death from COVID-19 suggested cardiac damage was common, but more from clotting than inflammation, researchers reported.

Autopsies on 40 people who died of COVID-19 showed that 14 had cardiac injury as indicated by myocardial necrosis: an acute myocardial infarction of at least 1 cm2 in three (7.5%) and smaller focal myocyte necrosis in 11 (27.5%).

Microthrombi were frequent, whereas none of those patients had myocarditis, except sarcoid involvement in one case, reported researchers at the virtual TCT Connect meeting.

Epicardial coronary artery thrombosis was found in two of the myocardial necrosis patients (14.2%) and microthrombi in nine (64.3%). The first case that prompted this investigation was one that presented with more intramyocardial capillary thrombi than she had ever seen.

"That alerted us so we made a concerted effort to look by multiple sections. We took as much as 10 sections from the myocardium, from every wall, from two levels so that we would not miss these things," researchers said at the session. "That's what led us to discover that there's more than just troponin I rise but really more to do with the fact that there is true necrosis and not so much myocarditis."

Ischemic EKG changes had been present in more of the myocardial necrosis cases (43% vs 8% without necrosis, P=0.03) and 44% of those with microthrombi. Notably, though, the virus was detected in the heart for only nine patients (22.5%), with no difference by myocardial necrosis or microthrombi presence.

It seems to be unlikely that the direct viral invasion of the heart is playing a major role in making myocardial necrosis and microthrombi," researchers told the virtual audience. The microthrombi were rich in platelets, fibrin II, and complement activation terminal products.

"New targeted therapeutic approaches are needed for the prevention and treatment of cardiac injury of the patients with COVID-19 disease," the authors concluded.

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