SARS-CoV-2 infection lacks definitive endomyocardial biopsy or autopsy proof of causing direct cardiomyocyte damage in association with histological myocarditis.
The review highlights the lack of definitive biopsy or autopsy proof of direct SARS-CoV-2 cardiomyocyte damage and recommends strict adherence to ESC/WHO diagnostic criteria to accurately estimate myocarditis incidence.
We review current data on clinically suspected European Society of Cardiology (ESC) 2013 criteria and biopsy-proven ESC and World Health Organization (WHO) criteria myocarditis that is temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ESC/WHO etiological diagnosis of viral myocarditis is based on histological and immunohistological evidence of nonischemic myocyte necrosis and monolymphocytic infiltration, i.e., myocarditis, plus the identification of a specific cardiotropic virus by molecular techniques, in particular polymerase chain reaction (PCR)/in-situ hybridization, on endomyocardial biopsy (EMB)/autopsy tissue. There is not yet definitive EMB/autopsy proof that SARS-CoV-2 causes direct cardiomyocyte damage in association with histological myocarditis. Clinical epidemiology data suggest that myocarditis is uncommon for both SARS-CoV-2-positive and -negative PCR cases. We hypothesize that the rare virus-negative biopsy-proven cases may represent new-onset immune-mediated or latent pre-existing autoimmune forms,triggered or fostered by the hyperinflammatory state of severe COVID-19. We recommend the application of the ESC/WHO definitions and diagnostic criteria in future reports to avoid low-quality scientific information leading to an inaccurate estimate of myocarditis incidence based on misdiagnosis.
Caforio et al. (Fri,) conducted a review in Myocarditis associated with SARS-CoV-2 infection. SARS-CoV-2 infection lacks definitive endomyocardial biopsy or autopsy proof of causing direct cardiomyocyte damage in association with histological myocarditis.