Cardiac inflammation and microvascular procoagulant changes are decreased in second wave compared to first wave deceased COVID-19 patients

Linghe Wu, Umit Baylan, Britt van der Leeden, Bernadette Schurink, Eva Roos, Casper G Schalkwijk, Marianna Bugiani, Paul van der Valk, Albert C van Rossum, Sacha S Zeerleder, Leo M A Heunks, Reinier A Boon, Onno J de Boer, Allard C van der Wal, Hans W M Niessen, Paul A J Krijnen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Compelling evidence has shown cardiac involvement in COVID-19 patients. However, the overall majority of these studies use data obtained during the first wave of the pandemic, while recently differences have been reported in disease course and mortality between first- and second wave COVID-19 patients. The aim of this study was to analyze and compare cardiac pathology between first- and second wave COVID-19 patients.

METHODS: Autopsied hearts from first- (n = 15) and second wave (n = 10) COVID-19 patients and from 18 non-COVID-19 control patients were (immuno)histochemically analyzed. CD45+ leukocyte, CD68+ macrophage and CD3+ T lymphocyte infiltration, cardiomyocyte necrosis and microvascular thrombosis were quantified. In addition, the procoagulant factors Tissue Factor (TF), Factor VII (FVII), Factor XII (FXII), the anticoagulant protein Dipeptidyl Peptidase 4 (DPP4) and the advanced glycation end-product N(ε)-Carboxymethyllysine (CML), as markers of microvascular thrombogenicity and dysfunction, were quantified.

RESULTS: Cardiac inflammation was significantly decreased in second wave compared to first wave COVID-19 patients, predominantly related to a decrease in infiltrated lymphocytes and the occurrence of lymphocytic myocarditis. This was accompanied by significant decreases in cardiomyocyte injury and microvascular thrombosis. Moreover, microvascular deposits of FVII and CML were significantly lower in second wave compared to first wave COVID-19 patients.

CONCLUSIONS: These results show that in our cohort of fatal COVID-19 cases cardiac inflammation, cardiomyocyte injury and microvascular thrombogenicity were markedly decreased in second wave compared to first wave patients. This may reflect advances in COVID-19 treatment related to an increased use of steroids in the second COVID-19 wave.

Original languageEnglish
Pages (from-to)157-165
Number of pages9
JournalInternational Journal of Cardiology
Volume349
DOIs
Publication statusPublished - 15 Feb 2022

Keywords

  • COVID-19/drug therapy
  • Humans
  • Inflammation
  • Pandemics
  • SARS-CoV-2
  • COVID-19
  • Heart
  • First and second wave
  • Thrombosis microvasculature
  • SARS-COV-2
  • MYOCARDITIS

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