Autopsy Study Finds Replicating SARS-CoV-2 in the Hearts of Long Covid

An autopsy study from the RECOVER program found replicating SARS-CoV-2 in the hearts of some patients with cardiac long COVID symptoms, researchers reported. The multi-institutional study examined left ventricle tissue from 74 decedents who were at least 60 days past their initial infection. Eleven cases tested positive for the viral reverse strand, a marker of active replication. Cardiac long COVID was present in 82% of those 11 cases compared with 37% of the 63 negative cases. The positive cases also showed higher heart-weight-to-wall-thickness ratios, more frequent left ventricular dilatation and more pericardial fluid. Viral spike gene was detected in cardiac myocytes, and gene expression analysis revealed alterations in 44 genes involved in inflammation and host response, particularly interferon regulatory factor 4. The authors said detection of the reverse strand provides molecular evidence of viral persistence that may drive structural and immune changes underlying symptoms. The findings were presented at a poster session titled Stowell-Orbison - Autopsy and Forensics.