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

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

NOX2 and NOX5 are increased in cardiac microvascular endothelium of deceased COVID-19 patients

“…The patients under investigation in this study have been used in a previous COVID-19 study [ 4 ]. The clinical characteristics of the included patients are presented in Table 1 .…”

“…For instance, endothelial damage, intravascular thrombosis and an elevated presence of prothrombotic proteins (e.g. tissue factor (TF), factor VII and factor FXII) have been found in the cardiac microvasculature of deceased COVID19 patients [ 4 , 5 ]. These results indicate that cardiac microvascular endothelial dysfunction may play an important role in COVID-19-induced cardiac injury and inflammation and as such relate to poor outcome [ 6 ].…”

RAGE pathway activation and function in chronic kidney disease and COVID-19

“…The N(ε)-Carboxymethyllysine (CML) advanced glycation end-product is an indicator of microvascular inflammation and dysfunction. In comparing autopsied hearts from non-COVID-19 patients and those from the COVID-19 first wave (February–June 2020) and second wave (September–December 2020), CML was found in the endothelium and smooth muscle cells of intramyocardial blood vessels and was elevated in the first wave in association with increased deposits of FVII and FXII clotting factors ( 110 ).…”

Evaluation of cardio-pulmonary functions of previously healthy adults with moderate-severe COVID-19 pneumonia after discharge

“…In this study, we selected the patients who suffered from COVID-19 pneumonia during the first wave of the pandemic as the morbidity and mortality were more in the first few months of pandemics. The use of intensive corticosteroids and vaccination against SARS CoV-2 resulted in a better prognosis recently (12,13). But the evaluation of patients affected formerly may help us to understand the consequences of the disease in naive cases, as there are still many people against vaccination.…”

“…) 13. patients from the moderate group and 11 patients from the severe group had a control thorax CT taken 1 month after discharge.…”