Saeed Soleiman-Meigooni
1* 
, Ramin Yaghmayee
2, Shadi Mohammadi
3, Mousa Ahmadi
4, Mehdi Sakhabakhsh
5, Ramin Hamidi-Farahani
4, Ebrahim Hazrati
6, Seyed Mohammad Jazayeri
7, Mahtab Fotoohi
2, Akram Motemaveleh
8, Vahid Doulatabadi-Farahani
9, Farhad Shahmohamadi
10, Mohammad Hassan Kazemi-Galougahi
11, Ali Asgari
4, Mohammad Aminianfar
4, Mohammad Darvishi
4, Mojgan Mohajeri-Iravani
12, Omid Gholizadeh
131 Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran
2 Department of Pathology, Khanevadeh University Hospital, Aja University of Medical Sciences, Tehran, Iran
3 Department of Obstetrics and Gynecology, Khanevadeh University Hospital, Aja University of Medical Sciences, Tehran, Iran
4 Department of Infectious Diseases, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
5 Department of Neurology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
6 Department of Anesthesiology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
7 Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
8 Department of Pulmonology, Khanevadeh University Hospital, Aja University of Medical Sciences, Tehran, Iran
9 Department of Cardiology, Khanevadeh University Hospital, Aja University of Medical Sciences, Tehran, Iran
10 Department of Forensic Medicine, Khanevadeh University Hospital, Aja University of Medical Sciences, Tehran, Iran
11 Department of Epidemiology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
12 Department of Anesthesiology, Faculty of Paramedical Sciences, Aja University of Medical Sciences, Tehran, Iran
13 Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: SARS-CoV-2 may affect vital organs. The present study investigated the histopathology of pulmonary and cardiac tissues with clinical correlation in deceased patients with COVID-19.
Methods: We obtained pulmonary and cardiac tissues from 30 deceased patients with COVID-19 in Tehran, Iran, from January to May 2021. Sampling was performed through a percutaneous needle biopsy. After slide preparation, two expert pathologists studied them. We assessed the correlation between clinical and pathological data by Fisher’s exact test.
Results: The mean age of the patients was 73.8±13.4 years, and the male-to-female ratio was 23/7. The most common underlying disease was hypertension (HTN) in 25 patients (83%). Fifty-five tissue samples were achieved, including 28 pulmonary and 27 cardiac samples. Our results showed that all patients (100%) developed diffuse alveolar damage (DAD), and 26 (93%) developed hyaline membrane formation. The most common phase of DAD was the exudative-proliferative phase in 16 (57.1%). Three cardiac samples (11%) revealed myocarditis, and seven (26%) showed cardiomyocyte hypertrophy. In univariate analysis using Fischer’s exact test, myocarditis had significant relationships with C-reactive protein (CRP) levels higher than 80 mg/dL (P=0.008) and elevated cardiac troponin levels higher than two-fold (P=0.01).
Conclusion: COVID-19 can affect the major vital organs. However, only myocarditis had a significant relationship with the circulating levels of inflammatory factors.