SARS-CoV-2, myocardial injury and inflammation: insights from a large clinical and autopsy study

Matteo Dal Ferro*, Rossana Bussani, Alessia Paldino, Vincenzo Nuzzi, Chiara Collesi, Lorena Zentilin, Edoardo Schneider, Ricardo Correa, Fulvio Silvestri, Serena Zacchigna, Mauro Giacca, Marco Metra, Marco Merlo, Gianfranco Sinagra

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)


Objective: Despite growing evidence about myocardial injury in hospitalized COronaVIrus Disease 2019 (COVID-19) patients, the mechanism behind this injury is only poorly understood and little is known about its association with SARS-CoV-2-mediated myocarditis. Furthermore, definite evidence of the presence and role of SARS-CoV-2 in cardiomyocytes in the clinical scenario is still lacking. Methods: We histologically characterized myocardial tissue of 40 patients deceased with severe SARS-CoV-2 infection during the first wave of the pandemic. Clinical data were also recorded and analyzed. In case of findings supportive of myocardial inflammation, histological analysis was complemented by RT-PCR and immunohistochemistry for SARS-CoV-2 viral antigens and in situ RNA hybridization for the detection of viral genomes. Results: Both chronic and acute myocardial damage was invariably present, correlating with the age and comorbidities of our population. Myocarditis of overt entity was found in one case (2.5%). SARS-CoV-2 genome was not found in the cardiomyocytes of the patient with myocarditis, while it was focally and negligibly present in cardiomyocytes of patients with known viral persistence in the lungs and no signs of myocardial inflammation. The presence of myocardial injury was not associated with myocardial inflammatory infiltrates. Conclusions: In this autopsy cohort of COVID-19 patients, myocarditis is rarely found and not associated with SARS-CoV-2 presence in cardiomyocytes. Chronic and acute forms of myocardial damage are constantly found and correlate with the severity of COVID-19 disease and pre-existing comorbidities. Graphic abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)1822-1831
Number of pages10
JournalClinical Research In Cardiology
Issue number11
Publication statusPublished - Nov 2021


  • Cardiac autopsy study
  • COVID-19
  • Myocardial injury
  • Myocarditis
  • Necrosis


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