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Lapii G.A.

Federal Research Center of Fundamental and Translational Medicine

Bakarev M.A.

Federal Research Center of Fundamental and Translational Medicine

Lushnikova E.L.

Federal Research Center of Fundamental and Translational Medicine

Morphological and immunohistochemical characteristics of the heart of patients with COVID-19

Authors:

Lapii G.A., Bakarev M.A., Lushnikova E.L.

More about the authors

Journal: Russian Journal of Archive of Pathology. 2026;88(1): 44‑51

DOI: 10.17116/patol20268801144

Read: 864 times

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Table of contents

MORPHOLOGICAL AND IMMUNOHISTOCHEMICAL CHARACTERISTICS OF THE HEART OF PATIENTS WITH COVID-19
MORPHOLOGICAL AND IMMUNOHISTOCHEMICAL CHARACTERISTICS OF THE HEART OF PATIENTS WITH COVID-19

To cite this article:

Lapii GA, Bakarev MA, Lushnikova EL. Morphological and immunohistochemical characteristics of the heart of patients with COVID-19. Russian Journal of Archive of Pathology. 2026;88(1):44‑51. (In Russ.)
https://doi.org/10.17116/patol20268801144

Подписка 2026 Архив патологии (Russian Journal of Archive of Pathology)
МСФ на ЯМ
Использование инфографики авторами научных работ
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Abstract:

OBJECTIVE

To analyze the pathomorphological and immunohistochemical characteristics of the hearts of patients who died from COVID-19.

MATERIAL AND METHODS

A comprehensive pathomorphologic study of the heart in 88 autopsies of patients who died from severe COVID-19 was performed. The presence of SARS-CoV-2 infection was confirmed by positive PCR tests in all cases. Immunohistochemical study was used to analyze the expression of viral nucleocapsid protein (NP), CD3, CD68, CD31, CD34, Willebrand factor (vWF) in cell populations and myocardial structures.

RESULTS

In most cases, polymorphism of structural changes was observed, which was expressed in a combination of signs of chronic and acute myocardial damage. Numerous foci of interstitial and perivascular fibrosis and lipomatosis, irregular hypertrophy of cardiomyocytes, amyloid deposits were indicative of previous cardiovascular diseases. Acute and subacute pathological changes in myocardium included circulatory disorders (hyperemia, intraluminal megakaryocytes, microvascular thrombosis, interstitial edema), vascular damage, and alterative changes in cardiomyocytes. Lymphomacrophage infiltration was present in 45% of cases and was associated with immunohistochemical detection of NP in cardiomyocytes and vascular cells. Weak expression of CD31 and high expression of vWF in microvascular endothelium was found.

CONCLUSION

NP expression in cardiomyocytes, macrophages and endothelial cells of cardiac vessels indicates their direct infection with SARS-CoV-2 virus and possible long-term persistence of viral infection. It was found that in severe COVID-19 CD3- and CD68-positive cells are detected in the heart; endothelial dysfunction is observed, which is indicated by decreased expression of CD31 and high expression of vWF. The identified myocardial changes may influence the development of post-COVID cardiovascular complications.

Keywords:

heart
COVID-19
pathomorphology
immunohistochemistry

Authors:

Lapii G.A.

Federal Research Center of Fundamental and Translational Medicine

Bakarev M.A.

Federal Research Center of Fundamental and Translational Medicine

Lushnikova E.L.

Federal Research Center of Fundamental and Translational Medicine

Received:

28.05.2025

Accepted:

22.10.2025

Close metadata

References:

  1. Deshmukh V, Motwani R, Kumar A, Kumari C, Raza K. Histopathological observations in COVID-19: a systematic review. J Clin Pathol. 2021;74(2):76-83.  https://doi.org/10.1136/jclinpath-2020-206995
  2. Peiris S, Mesa H, Aysola A, Manivel J, Toledo J, Borges-Sa M, Aldighieri S, Reveiz L. Pathological findings in organs and tissues of patients with COVID-19: A systematic review. PLoS One. 2021;16(4):e0250708. https://doi.org/10.1371/journal.pone.0250708
  3. Mallhi TH, Safdar A, Butt MH, Salman M, Nosheen S, Mustafa ZU, Khan FU, Khan YH. Atypical Complications during the Course of COVID-19: A Comprehensive Review. Medicina (Kaunas). 2024;60(1):164.  https://doi.org/10.3390/medicina60010164
  4. Roshdy A, Zaher S, Fayed H, Coghlan JG. COVID-19 and the Heart: A Systematic Review of Cardiac Autopsies. Front Cardiovasc Med. 2021;7:626975. https://doi.org/10.3389/fcvm.2020.626975
  5. Sang CJ 3rd, Burkett A, Heindl B, Litovsky SH, Prabhu SD, Benson PV, Rajapreyar I. Cardiac pathology in COVID-19: a single center autopsy experience. Cardiovasc Pathol. 2021:107370. https://doi.org/10.1016/j.carpath.2021.107370
  6. Dal Ferro M, Bussani R, Paldino A, Nuzzi V, Collesi C, Zentilin L, Schneider E, Correa R, Silvestri F, Zacchigna S, Giacca M, Metra M, Merlo M, Sinagra G. SARS-CoV-2, myocardial injury and inflammation: insights from a large clinical and autopsy study. Clin Res Cardiol. 2021;110(11):1822-1831. https://doi.org/10.1007/s00392-021-01910-2
  7. Philip B, Mukherjee P, Khare Y, Ramesh P, Zaidi S, Sabry H, Harky A. COVID-19 and its long-term impact on the cardiovascular system. Expert Rev Cardiovasc Ther. 2023;21(3):211-218.  https://doi.org/10.1080/14779072.2023.2184800
  8. Sewanan LR, Clerkin KJ, Tucker NR, Tsai EJ. How Does COVID-19 Affect the Heart? Curr Cardiol Rep. 2023;25(3):171-184.  https://doi.org/10.1007/s11886-023-01841-6
  9. Mitrofanova L.B., Makarov I.A., Runov A.L., Vonsky M.S., Danilova I.A., Sidorin V.S., Moiseva O.M., Conradi A.O. Clinical, morphological and molecular biological examination of the myocardium in COVID-19 patients. Russian Journal of Cardiology. 2022;27(7):4810. (In Russ.). https://doi.org/10.15829/1560-4071-2022-4810
  10. Akhmerov A, Marbán E. COVID-19 and the Heart. Circ Res. 2020;126(10):1443-1455. https://doi.org/10.1161/CIRCRESAHA.120.317055
  11. Aleksova A, Fluca AL, Gagno G, Pierri A, Padoan L, Derin A, Moretti R, Noveska EA, Azzalini E, D’Errico S, Beltrami AP, Zumla A, Ippolito G, Sinagra G, Janjusevic M. Long-term effect of SARS-CoV-2 infection on cardiovascular outcomes and all-cause mortality. Life Sci. 2022;310:121018. https://doi.org/10.1016/j.lfs.2022.121018
  12. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.  https://doi.org/10.1038/s41591-022-01689-3
  13. Tobler DL, Pruzansky AJ, Naderi S, Ambrosy AP, Slade JJ. Long-Term Cardiovascular Effects of COVID-19: Emerging Data Relevant to the Cardiovascular Clinician. Curr Atheroscler Rep. 2022;24(7):563-570.  https://doi.org/10.1007/s11883-022-01032-8
  14. Singh TK, Zidar DA, McCrae K, Highland KB, Englund K, Cameron SJ, Chung MK. A Post-Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2. Circ Res. 2023;132(10):1358-1373. https://doi.org/10.1161/CIRCRESAHA.122.322228
  15. Mezache L, Nuovo GJ, Suster D, Tili E, Awad H, Radwański PB, Veeraraghavan R. Histologic, viral, and molecular correlates of heart disease in fatal COVID-19. Ann Diagn Pathol. 2022;60:151983. https://doi.org/10.1016/j.anndiagpath.2022.151983
  16. Kern L, Mittenbühler MJ, Vesting AJ, Ostermann AL, Wunderlich CM, Wunderlich FT. Obesity-Induced TNFα and IL-6 Signaling: The Missing Link between Obesity and Inflammation-Driven Liver and Colorectal Cancers. Cancers (Basel). 2018;11(1):24.  https://doi.org/10.3390/cancers11010024
  17. Rapkiewicz AV, Mai X, Carsons SE, Pittaluga S, Kleiner DE, Berger JS, Thomas S, Adler NM, Charytan DM, Gasmi B, Hochman JS, Reynolds HR. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series. EClinicalMedicine. 2020;24:100434. https://doi.org/10.1016/j.eclinm.2020.100434
  18. Bois MC, Boire NA, Layman AJ, Aubry MC, Alexander MP, Roden AC, Hagen CE, Quinton RA, Larsen C, Erben Y, Majumdar R, Jenkins SM, Kipp BR, Lin PT, Maleszewski JJ. (2021). COVID-19-Associated Nonocclusive Fibrin Microthrombi in the Heart. Circulation. 2021 143(3): 230-243.  https://doi.org/10.1161/CIRCULATIONAHA.120.050754
  19. Mikhaleva L, Gioeva Z, Varyasin V, Berezhnaja E, Vandysheva R, Gutyrchik N, Pechnikova V, Kontorshchikov A, Midiber K, Kakturskij L. Pathomorphological Features of the Novel Coronavirus Disease in Patients with Systemic Amyloidosis. Biomedicines. 2023;11(10):2811. https://doi.org/10.3390/biomedicines11102811
  20. Halushka MK, Vander Heide RS. Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations. Cardiovasc Pathol. 2021;50:107300. https://doi.org/10.1016/j.carpath.2020.107300
  21. Oprinca GC, Muja LA. Postmortem examination of three SARS-CoV-2-positive autopsies including histopathologic and immunohistochemical analysis. Int J Legal Med. 2021;135(1):329-339.  https://doi.org/10.1007/s00414-020-02406-w
  22. Panagiotides NG, Poledniczek M, Andreas M, Hülsmann M, Kocher AA, Kopp CW, Piechota-Polanczyk A, Weidenhammer A, Pavo N, Wadowski PP. Myocardial Oedema as a Consequence of Viral Infection and Persistence-A Narrative Review with Focus on COVID-19 and Post COVID Sequelae. Viruses. 2024;16(1):121.  https://doi.org/10.3390/v16010121
  23. Maccio U, Zinkernagel AS, Shambat SM, Zeng X, Cathomas G, Ruschitzka F, Schuepbach RA, Moch H, Varga Z. SARS-CoV-2 leads to a small vessel endotheliitis in the heart. EBioMedicine. 2021;63:103182. https://doi.org/10.1016/j.ebiom.2020.103182
  24. Blagova OV, Kogan EA, Lutokhina YuA, Kukleva AD, Ainetdinova DH, Novosadov VM, Rud` RS, Zaitsev AYu, Zaidenov VA, Kupriyanova AG, Alexandrova SA, Fomin VV. Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms. Kardiologiia. 2021;61(6):11-27. (In Russ.) https://doi.org/10.18087/cardio.2021.6.n1659
  25. Kogan EA, Kukleva AD, Berezovsky YuS, Blagova OV, Zharkov NV, Ainetdinova DKh, Demyashkin GA. Clinical and morphological characteristics of SARS-CoV-2-related myocarditis proven by the presence of viral RNA and proteins in myocardial tissue. Russian Journal of Archive of Pathology. 2021;83(4):5-13. (In Russ.). https://doi.org/10.17116/patol2021830415
  26. Nappi F, Avtaar Singh SS. SARS-CoV-2-Induced Myocarditis: A State-of-the-Art Review. Viruses. 2023;15(4):916.  https://doi.org/10.3390/v15040916
  27. Zinserling VA, Vashukova MA, Vasilyeva MV, Isakov AN, Lugovskaya NA, Narkevich TA, Sukhanova YuV, Semenova NYu, Gusev DA. Issues of pathology of a new coronavirus infection CoVID-19. Journal Infectology. 2020;12(2):5-11. (In Russ.). https://doi.org/10.22625/2072-6732-2020-12-2-5-11
  28. Lertkiatmongkol P, Liao D, Mei H, Hu Y, Newman PJ. Endothelial functions of platelet/endothelial cell adhesion molecule-1 (CD31). Curr Opin Hematol. 2016;23(3):253-9.  https://doi.org/10.1097/MOH.0000000000000239
  29. Liao D, Mei H, Hu Y, Newman DK, Newman PJ. CRISPR-mediated deletion of the PECAM-1 cytoplasmic domain increases receptor lateral mobility and strengthens endothelial cell junctional integrity. Life Sci. 2018;193:186-193.  https://doi.org/10.1016/j.lfs.2017.11.002
  30. Mojiri A, Alavi P, Lorenzana Carrillo MA, Nakhaei-Nejad M, Sergi CM, Thebaud B, Aird WC, Jahroudi N. Endothelial cells of different organs exhibit heterogeneity in von Willebrand factor expression in response to hypoxia. Atherosclerosis. 2019;282:1-10.  https://doi.org/10.1016/j.atherosclerosis.2019.01.002
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