Unexpected Features of Cardiac Pathology in COVID-19 Infection

Abstract

heart failure ◼ SARS virus ◼ severe acute respiratory syndrome T his Research Letter expands our previous report of 10 hearts 1 by adding an additional 12 hearts (for a total of 22 hearts) from deaths confirmed attributable to coronavirus disease 2019 (COVID-19) infection.We identify key gross and microscopic changes that challenge the notion that typical myocarditis is present in severe acute respiratory syndrome coronavirus 2 infection.We speculate on alternative mechanisms for cardiac injury that should be investigated to provide a better understanding of the cardiac manifestations of COVID-19.In each case, consent for autopsy was granted by the next of kin.These studies were determined exempt by the institutional review board at LSU Health Sciences Center and Tulane University.Representative sections of the left and right ventricles were submitted for routine histology.All sections were stained with hematoxylin and eosin and examined by an experienced cardiovascular pathologist.A subset of the sections was selected for additional immunostaining for lymphocytes, endothelial cells, and DNA/RNA using CD4, CD8, and CD31 antibodies and DRAQ5 (Bio status)/StrandBrite Green (ATT Bioquest) labeling, respectively.