Letter by Wong and Siu Regarding Article, “Microthrombi as a Major Cause of Cardiac Injury in COVID-19: A Pathologic Study”

HomeCirculationVol. 144, No. 7Letter by Wong and Siu Regarding Article, “Microthrombi as a Major Cause of Cardiac Injury in COVID-19: A Pathologic Study” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter Chun-Ka Chung-Wah WongChun-Ka https://orcid.org/0000-0001-5205-9440 Cardiology Division, Department Medicine, University Hong Kong, Kong SAR, China. Search for more papers this author SiuChung-Wah https://orcid.org/0000-0002-2666-3086 Originally published16 Aug 2021https://doi.org/10.1161/CIRCULATIONAHA.121.054509Circulation. 2021;144:e156–e157To the Editor:Acute myocardial injury evidenced an elevated troponin level is disproportionally prevalent hospitalized patients with coronavirus disease 2019 (COVID-19) compared other respiratory viral illnesses such influenza. The proposed mechanisms include direct cytopathogenic effects, viral-induced or immune-mediated myocarditis, cytokine storm, arterial microthromboembolic phenomenon.1 In recent article Circulation entitled Pathological Study,”2 Pellegrini colleagues described cardiac autopsy findings 40 COVID-19 who succumbed during course.In study, necrosis was detected 14 deceased patients, including 3 initially presented ST-segment–elevation infarction, whom 9 (78.6%) were found have microthrombi. Thus, authors concluded that microthrombi are most common pathological cause necrosis. Although these certainly add valuable puzzle piece big picture COVID-19–related damage, their generalizability totality population rather limited. Obviously, study cohort represents older (median age: 74 years) multiple cardiovascular risk factors diseases together severe COVID-19, whose predominant pathogenic mechanism acute may differ from younger age no preexisting factors. For instance, involving 100 consecutive survivors (mean 49 overt manifestations course, magnetic resonance features ongoing inflammation 60% endomyocardial biopsies confirmed active lymphocytic myocarditis.3Arguably, it remains possible remnants coronary thrombi clinically undetected events, which then partially resolved embolized distally over than microvascular thrombosis. This supported fact majority cases, focal (7 11 patients) confined single territory instead diffuse involvement. Thereby, provision clinical information pertaining temporal relationship between rise, ECG changes, death shed light on origin Nonetheless, given high prevalence ischemic changes elevation, many would fulfill 2 diagnostic criteria non–ST-segment–elevation infarction qualify antithrombotic agents according current international guidelines syndrome.Last but not least, manifestation abnormalities protean, ranging rhythm abnormalities, elevation biomarkers, ventricular dysfunction, even uneventful recovery.4 Ongoing investigations indicated long-term consequences abnormality. To end, we congratulate publishing data, appreciate efforts challenging work amid pandemic COVID-19.Disclosures None.Footnoteshttps://www.ahajournals.org/journal/circReferences1. CK, Luk HK, Lai WH, Lau YM, Zhang RR, AC, Lo GC, Chan KH, Hung IF, Tse HF, et al. Human-induced pluripotent stem cell-derived cardiomyocytes platform SARS-CoV-2 related injury.Circ J. 2020; 84:2027–2031. doi: 10.1253/circj.CJ-20-0881CrossrefMedlineGoogle Scholar2. D, Kawakami R, Guagliumi G, Sakamoto A, Kawai K, Gianatti Nasr Kutys Guo L, Cornelissen Microthrombi major pathologic study.Circulation. 2021; 143:1031–1042. 10.1161/CIRCULATIONAHA.120.051828LinkGoogle Scholar3. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, Shchendrygina Escher F, Vasa-Nicotera Zeiher AM, Outcomes imaging recently recovered (COVID-19).JAMA Cardiol. 5:1265–1273. 10.1001/jamacardio.2020.3557CrossrefMedlineGoogle Scholar4. Zhou Un KC, Lee JC, Tam FC, AR, Lam YY, Cardiovascular sequalae uncomplicated survivors.PLoS One. 16:e0246732. 10.1371/journal.pone.0246732CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate published journal forum providing unpublished data. Comments reviewed appropriate use tone language. peer-reviewed. Acceptable comments posted website only. issue indexed PubMed. be longer 500 words will only online. References limited 10. Authors cited comment invited reply, appropriate.Comments feedback AHA/ASA Scientific Statements Guidelines directed Manuscript Oversight Committee via its Correspondence page.Sign Submit Response Article Previous Back top Next FiguresReferencesRelatedDetails August 17, 2021Vol Issue 7 Advertisement InformationMetrics © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.121.054509PMID: 34398684 publishedAugust 16, PDF download SubjectsAcute Coronary SyndromesEthics PolicyThrombosis