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A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "Human Virology and Viral Diseases".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 27823

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Special Issue Editors

Prof. Dr. Gianluca Rigatelli

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Guest Editor

Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Viale Tre Martiri, 45100 Rovigo, Italy
Interests: coronary bifurcation; stent; coronary artery; left main coronary artery; percutaneous coronary interventions; interventional cardiology; congenital heart disease; patent foramen ovale

Dr. Marco Zuin

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Guest Editor

1. Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
2. Division of Cardiology, West Vicenza General Hospitals, Arzignano, 36071 Vicenza, Italy
Interests: pulmonary embolism; interventional cardiology; congenital heart disease; cardiovascular risk; COVID-19 and cardiovascular disease; heart failure; atrial fibrillation

Prof. Dr. Claudio Bilato

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Guest Editor

Division of Cardiology, West Vicenza General Hospitals, Arzignano, 36071 Vicenza, Italy
Interests: atherosclerosis; takotsubo cardiomyopathy; dyslipidemia; myocardial infarction; clinical cardiology; geriatric cardiology

Special Issue Information

Dear Colleagues,

The novel SARS coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has caused an unprecedented pandemic worldwide. The cardiovascular system is one of the major systems affected by the viral infection. Indeed, infected patients may develop several cardiovascular complications which are associated with poor outcomes. Similarly, the presence of pre-existing cardiac disease increases mortality in COVID-19 patients.

In this Special Issue, entitled “COVID-19 and Cardiac Injury”, we aim to present research and theoretical papers addressing all these questions and many other related to the interaction between COVID-19 infection and cardiac injuries. Thus, we invite colleagues working and/or involved in any field related to COVID-19 and cardiac disease to submit their work for publication in this Special Issue. We believe that this Special Issue will not only be very timely but also scientifically innovative and exciting.

Prof. Dr. Gianluca Rigatelli
Dr. Marco Zuin
Prof. Dr. Claudio Bilato
Guest Editors

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Keywords

COVID-19
cardiovascular disease
cardiac injuries
arrhythmias
cardiac complications

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13 pages, 453 KiB

Open AccessArticle

COVID-19 and Heart Failure with Preserved and Reduced Ejection Fraction Clinical Outcomes among Hospitalized Patients in the United States

by Adeel Nasrullah, Karthik Gangu, Harmon R. Cannon, Umair A. Khan, Nichole B. Shumway, Aneish Bobba, Shazib Sagheer, Prabal Chourasia, Hina Shuja, Sindhu Reddy Avula, Rahul Shekhar and Abu Baker Sheikh

Viruses 2023, 15(3), 600; https://doi.org/10.3390/v15030600 - 22 Feb 2023

Cited by 4 | Viewed by 2704

Abstract

Heart failure exacerbations impart significant morbidity and mortality, however, large- scale studies assessing outcomes in the setting of concurrent coronavirus disease-19 (COVID-19) are limited. We utilized National Inpatient Sample (NIS) database to compare clinical outcomes in patients admitted with acute congestive heart failure exacerbation (CHF) with and without COVID-19 infection. A total of 2,101,980 patients (Acute CHF without COVID-19 (n = 2,026,765 (96.4%) and acute CHF with COVID-19 (n = 75,215, 3.6%)) were identified. Multivariate logistic regression analysis was utilized to compared outcomes and were adjusted for age, sex, race, income level, insurance status, discharge quarter, Elixhauser co-morbidities, hospital location, teaching status and bed size. Patients with acute CHF and COVID-19 had higher in-hospital mortality compared to patients with acute CHF alone (25.78% vs. 5.47%, adjust OR (aOR) 6.3 (95% CI 6.05–6.62, p < 0.001)) and higher rates of vasopressor use (4.87% vs. 2.54%, aOR 2.06 (95% CI 1.86–2.27, p < 0.001), mechanical ventilation (31.26% vs. 17.14%, aOR 2.3 (95% CI 2.25–2.44, p < 0.001)), sudden cardiac arrest (5.73% vs. 2.88%, aOR 1.95 (95% CI 1.79–2.12, p < 0.001)), and acute kidney injury requiring hemodialysis (5.56% vs. 2.94%, aOR 1.92 (95% CI 1.77–2.09, p < 0.001)). Moreover, patients with heart failure with reduced ejection fraction had higher rates of in-hospital mortality (26.87% vs. 24.5%, adjusted OR 1.26 (95% CI 1.16–1.36, p < 0.001)) with increased incidence of vasopressor use, sudden cardiac arrest, and cardiogenic shock as compared to patients with heart failure with preserved ejection fraction. Furthermore, elderly patients and patients with African-American and Hispanic descents had higher in-hospital mortality. Acute CHF with COVID-19 is associated with higher in-hospital mortality, vasopressor use, mechanical ventilation, and end organ dysfunction such as kidney failure and cardiac arrest. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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15 pages, 1673 KiB

Open AccessArticle

COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample

by Monique G. Davis, Aniesh Bobba, Prabal Chourasia, Karthik Gangu, Hina Shuja, Dima Dandachi, Asif Farooq, Sindhu Reddy Avula, Rahul Shekhar and Abu Baker Sheikh

Viruses 2022, 14(12), 2791; https://doi.org/10.3390/v14122791 - 14 Dec 2022

Cited by 12 | Viewed by 3140

Abstract

Coronavirus-19 (COVID-19), preliminarily a respiratory virus, can affect multiple organs, including the heart. Myocarditis is a well-known complication among COVID-19 infections, with limited large-scale studies evaluating outcomes associated with COVID-19-related Myocarditis. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without Myocarditis. A total of 1,659,040 patients were included in the study: COVID-19 with Myocarditis (n = 6,455, 0.4%) and COVID-19 without Myocarditis (n = 1,652,585, 99.6%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, sudden cardiac arrest, cardiogenic shock, acute kidney injury requiring hemodialysis, length of stay, health care utilization costs, and disposition. We conducted a secondary analysis with propensity matching to confirm results obtained by traditional multivariate analysis. COVID-19 patients with Myocarditis had significantly higher in-hospital mortality compared to COVID-19 patients without Myocarditis (30.5% vs. 13.1%, adjusted OR: 3 [95% CI 2.1–4.2], p < 0.001). This cohort also had significantly increased cardiogenic shock, acute kidney injury requiring hemodialysis, sudden cardiac death, required more mechanical ventilation and vasopressor support and higher hospitalization cost. Vaccination and more research for treatment strategies will be critical for reducing worse outcomes in patients with COVID-19-related Myocarditis. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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6 pages, 784 KiB

Open AccessArticle

Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region

by Marco Zuin, Giacomo Mugnai, Alberto Zamboni, Edlira Zakja, Roberto Valle, Giovanni Turiano, Sakis Themistoclakis, Daniele Scarpa, Salvatore Saccà, Loris Roncon, Francesca Rizzetto, Paola Purita, Angela Polo, Ivan Pantano, Antonio Mugnolo, Giulio Molon, Samuele Meneghin, Daniela Mancuso, Micaela Lia, Giuseppe Grassi, Ada Cutolo, Fabio Chirillo, Paolo Bozzini, Stefano Bonapace, Maurizio Anselmi, Gianluca Rigatelli and Claudio Bilato Show full author list Hide full author list

Viruses 2022, 14(9), 1925; https://doi.org/10.3390/v14091925 - 30 Aug 2022

Cited by 5 | Viewed by 1555

Abstract

Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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22 pages, 2085 KiB

Open AccessArticle

The Usefulness of the C₂HEST Risk Score in Predicting Clinical Outcomes among Hospitalized Subjects with COVID-19 and Coronary Artery Disease

by Piotr Rola, Adrian Doroszko, Małgorzata Trocha, Damian Gajecki, Jakub Gawryś, Tomasz Matys, Katarzyna Giniewicz, Krzysztof Kujawa, Marek Skarupski, Barbara Adamik, Krzysztof Kaliszewski, Katarzyna Kiliś-Pstrusińska, Agnieszka Matera-Witkiewicz, Michał Pomorski, Marcin Protasiewicz, Marcin Madziarski, Marta Madej, Grzegorz Gogolewski, Goutam Chourasia, Dorota Zielińska, Szymon Włodarczak, Maciej Rabczyński, Janusz Sokołowski, Ewa Anita Jankowska and Katarzyna Madziarska Show full author list Hide full author list

Viruses 2022, 14(8), 1771; https://doi.org/10.3390/v14081771 - 14 Aug 2022

Cited by 2 | Viewed by 2602

Abstract

Background: Even though coronary artery disease (CAD) is considered an independent risk factor of an unfavorable outcome of SARS-CoV-2-infection, the clinical course of COVID-19 in subjects with CAD is heterogeneous, ranging from clinically asymptomatic to fatal cases. Since the individual C₂HEST components are similar to the COVID-19 risk factors, we evaluated its predictive value in CAD subjects. Materials and Methods: In total, 2183 patients hospitalized due to confirmed COVID-19 were enrolled onto this study consecutively. Based on past medical history, subjects were assigned to one of two of the study arms (CAD vs. non-CAD) and allocated to different risk strata, based on the C₂HEST score. Results: The CAD cohort included 228 subjects, while the non-CAD cohort consisted of 1956 patients. In-hospital, 3-month and 6-month mortality was highest in the high-risk C₂HEST stratum in the CAD cohort, reaching 43.06%, 56.25% and 65.89%, respectively, whereas in the non-CAD cohort in the high-risk stratum, it reached: 26.92%, 50.77% and 64.55%. Significant differences in mortality between the C₂HEST stratum in the CAD arm were observed in post hoc analysis only for medium- vs. high-risk strata. The C₂HEST score in the CAD cohort could predict hypovolemic shock, pneumonia and acute heart failure during hospitalization, whereas in the non-CAD cohort, it could predict cardiovascular events (myocardial injury, acute heart failure, myocardial infract, carcinogenic shock), pneumonia, acute liver dysfunction and renal injury as well as bleedings. Conclusions: The C₂HEST score is a simple, easy-to-apply tool which might be useful in risk stratification, preferably in non-CAD subjects admitted to hospital due to COVID-19. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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10 pages, 563 KiB

Open AccessArticle

Fixed-Dose Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Pulmonary Embolism Associated with COVID-19

by Davide Voci, Stéphanie Zbinden, Evy Micieli, Nils Kucher and Stefano Barco

Viruses 2022, 14(8), 1606; https://doi.org/10.3390/v14081606 - 22 Jul 2022

Cited by 4 | Viewed by 1998

Abstract

Background. Fixed-dose ultrasound-assisted catheter-directed thrombolysis (USAT) rapidly improves hemodynamic parameters and reverses right ventricular dysfunction caused by acute pulmonary embolism (PE). The effectiveness of USAT for acute PE associated with coronavirus disease 2019 (COVID-19) is unknown. Methods and results. The study population of this cohort study consisted of 36 patients with an intermediate-high- or high-risk acute PE treated with a fixed low-dose USAT protocol (r-tPA 10–20 mg/15 h). Of these, 9 patients tested positive for COVID-19 and were age–sex-matched to 27 patients without COVID-19. The USAT protocol included, beyond the infusion of recombinant tissue plasminogen activator, anti-Xa-activity-adjusted unfractionated heparin therapy (target 0.3–0.7 U/mL). The study outcomes were the invasively measured mean pulmonary arterial pressure (mPAP) before and at completion of USAT, and the National Early Warning Score (NEWS), according to which more points indicate more severe hemodynamic impairment. Twenty-four (66.7%) patients were men; the mean age was 67 ± 14 years. Mean ± standard deviation mPAP decreased from 32.3 ± 8.3 to 22.4 ± 7.0 mmHg among COVID-19 patients and from 35.4 ± 9.7 to 24.6 ± 7.0 mmHg among unexposed, with no difference in the relative improvement between groups (p = 0.84). Within 12 h of USAT start, the median NEWS decreased from six (Q1–Q3: 4–8) to three (Q1–Q3: 2–4) points among COVID-19 patients and from four (Q1–Q3: 2–6) to two (Q1–Q3: 2–3) points among unexposed (p = 0.29). One COVID-19 patient died due to COVID-19-related complications 14 days after acute PE. No major bleeding events occurred. Conclusions. Among patients with COVID-19-associated acute PE, mPAP rapidly decreased during USAT with a concomitant progressive improvement of the NEWS. The magnitude of mPAP reduction was similar in patients with and without COVID-19. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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31 pages, 4595 KiB

Open AccessReview

SARS-CoV-2-Induced Myocarditis: A State-of-the-Art Review

by Francesco Nappi and Sanjeet Singh Avtaar Singh

Viruses 2023, 15(4), 916; https://doi.org/10.3390/v15040916 - 2 Apr 2023

Cited by 8 | Viewed by 5058

Abstract

In this review, we investigated whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly cause myocarditis with severe myocardial damage induced by viral particles. A review of the major data published from 2020 to 2022 was performed by consulting the major databases alongside first-hand experiences that emerged from the cardiac biopsies and autopsy examinations of patients who died of SARS-CoV-2 infections. From this study, a significantly large amount of data suggests that the Dallas criteria were met in a residual percentage of patients, demonstrating that SARS-CoV-2 myocarditis was a rare clinical and pathological entity that occurred in a small percentage of subjects. All cases described here were highly selected and subjected to autopsies or endomyocardial biopsies (EMBs). The most important discovery, through the detection of the SARS-CoV-2 genome using the polymerase chain reaction, consisted in the presence of the viral genome in the lung tissue of most of the patients who died from COVID-19. However, the discovery of the SARS-CoV-2 viral genome was a rare event in cardiac tissue from autopsy findings of patients who died of myocarditis It is important to emphasize that myocardial inflammation alone, as promoted by macrophages and T cell infiltrations, can be observed in noninfectious deaths and COVID-19 cases, but the extent of each cause is varied, and in neither case have such findings been reported to support clinically relevant myocarditis. Therefore, in the different infected vs. non-infected samples examined, none of our findings provide a definitive histochemical assessment for the diagnosis of myocarditis in the majority of cases evaluated. We report evidence suggesting an extremely low frequency of viral myocarditis that has also been associated with unclear therapeutic implications. These two key factors strongly point towards the use of an endomyocardial biopsy to irrefutably reach a diagnosis of viral myocarditis in the context of COVID-19. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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18 pages, 282 KiB

Open AccessReview

Short and Long-Term Cardiovascular Sequelae after SARS-CoV-2 Infection: A Narrative Review Focusing on Athletes

by Sara Monosilio, Silvia Prosperi, Maria Rosaria Squeo, Stefano Spataro, Antonio Spataro and Viviana Maestrini

Viruses 2023, 15(2), 493; https://doi.org/10.3390/v15020493 - 10 Feb 2023

Cited by 3 | Viewed by 2425

Abstract

Cardiovascular (CV) involvement after severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection was found to be frequent among the general population, especially in the pre-vaccination era, and particularly for hospitalized patients or those who experienced a more severe course of the disease. The spectrum of CV disease varies; however, acute myocarditis is particularly fearsome for the athletic population due to the possible associated risk of malignant arrhythmias during training. Alarming percentages of CV injuries, even in young and healthy athletes with a benign course of the disease, arose from a few initial studies limited to case series. Subsequent single-center studies and larger observational registries reported a lower prevalence of SARS-CoV2 CV involvement in athletes. Studies showing the occurrence of CV adverse events during follow-up periods are now available. The objective of our narrative review is to provide an updated summary of the literature on CV involvement after coronavirus disease 2019, both in the early post-infection period and over a longer period of time, with a focus on athletic populations. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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9 pages, 1344 KiB

Open AccessCommentary

Diagnosis of Acute Myocarditis Following mRNA Vaccines against SARS-CoV-2: A Methodological Review

by Marco Zuin, Emma Zimelli, Chiara Dalla Valle, Stefano Cavedon, Gianluca Rigatelli and Claudio Bilato

Viruses 2023, 15(4), 929; https://doi.org/10.3390/v15040929 - 7 Apr 2023

Cited by 1 | Viewed by 1942

Abstract

The occurrence of acute myocarditis following the administration of mRNA vaccines against SARS-CoV-2 remains relatively rare, and it is associated with a very low mortality rate. The incidence varied by vaccine type, sex, and age and after the first, second, or third vaccination dose. However, the diagnosis of this condition often remains challenging. To further elucidate the relationship between myocarditis and SARS-CoV-2 mRNA vaccines, starting with two cases observed at the Cardiology Unit of the West Vicenza General Hospital located in the Veneto Region, which was among the first Italian areas hit by the COVID-19 pandemic, we performed a review of the available literature to highlight the clinical and diagnostic elements that could contribute to suspicion of myocarditis as an adverse event of SARS-CoV-2 immunization. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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9 pages, 867 KiB

Open AccessBrief Report

Takotsubo Syndrome during COVID-19 Pandemic in the Veneto Region, Italy

by Marco Zuin, Giacomo Mugnai, Maurizio Anselmi, Stefano Bonapace, Paolo Bozzini, Fabio Chirillo, Ada Cutolo, Giuseppe Grassi, Daniela Mancuso, Samuele Meneghin, Giulio Molon, Antonio Mugnolo, Ivan Pantano, Angela Polo, Paola Purita, Loris Roncon, Salvatore Saccà, Daniele Scarpa, Domenico Tavella, Sakis Themistoclakis, Giovanni Turiano, Roberto Valle, Maddalena Widmann, Edlira Zakja, Alberto Zamboni, Gianluca Rigatelli and Claudio Bilato Show full author list Hide full author list

Viruses 2022, 14(9), 1971; https://doi.org/10.3390/v14091971 - 6 Sep 2022

Cited by 6 | Viewed by 1658

Abstract

Background: During the COVID-19 pandemic, the risk of SARS-CoV-2 infection, the public health measures of social distancing, the freedom limitations, quarantine, and the enforced homeworking under the lockdown period, as well as medical causes including COVID-19 infection per se, may have caused major emotional distress, especially in the most vulnerable patients. We aimed to evaluate the variations in the number of admissions due to Takotsubo syndrome (TTS) during the COVID-19 pandemic in the Veneto region. Methods: We retrospectively reviewed and analyzed the number of admissions because of TTS in 13 Divisions of Cardiology located in the Veneto region, the northeastern area of Italy, covering a population of more than 2.5 million inhabitants, during the two major pandemic waves of COVID-19 (the first between 15 March and 30 April 2020 and the second between 15 November and 30 December 2020) that occurred in 2020. Results: In total, 807 acute coronary syndromes were admitted in the 13 enrolling hospitals. Among these, 3.9% had TTS. Compared to the corresponding 2018 and 2019 time periods, we observed a significant increase in the number of TTS cases (+15.6%, p = 0.03 and +12.5%, p = 0.04, comparing 2018 to 2020 and 2019 to 2020, respectively). Geographical distribution of the TTS cases reflected the broad spread of the SARS-CoV-2 infection with a significant direct relationship between TTS incidence and the number of COVID-19 infections according to Pearson’s correlation (r = 0.798, p < 0.001). Conclusions: The higher incidence of TTS during the 2020 COVID-19 pandemic waves, especially in the areas that were hit hardest in terms of morbidity and mortality by the SARS-CoV-2 infection, suggest a strong direct and/or indirect role of COVID-19 in the pathogenesis of TTS. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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12 pages, 4083 KiB

Open AccessCase Report

Myocardial Infarction Following COVID-19 Vaccine Administration: Post Hoc, Ergo Propter Hoc?

by Arianna Baronti, Francesco Gentile, Alice Chiara Manetti, Andrea Scatena, Silvia Pellegrini, Angela Pucci, Maria Franzini, Vincenzo Castiglione, Aniello Maiese, Alberto Giannoni, Mauro Pistello, Michele Emdin, Giovanni Donato Aquaro and Marco Di Paolo

Viruses 2022, 14(8), 1644; https://doi.org/10.3390/v14081644 - 27 Jul 2022

Cited by 19 | Viewed by 3533

Abstract

Vaccination against coronavirus disease 2019 (COVID-19) is the safest and most effective strategy for controlling the pandemic. However, some cases of acute cardiac events following vaccine administration have been reported, including myocarditis and myocardial infarction (MI). While post-vaccine myocarditis has been widely discussed, information about post-vaccine MI is scarce and heterogenous, often lacking in histopathological and pathophysiological details. We hereby present five cases (four men, mean age 64 years, range 50–76) of sudden death secondary to MI and tightly temporally related to COVID-19 vaccination. In each case, comprehensive macro- and microscopic pathological analyses were performed, including post-mortem cardiac magnetic resonance, to ascertain the cause of death. To investigate the pathophysiological determinants of MI, toxicological and tryptase analyses were performed, yielding negative results, while the absence of anti-platelet factor 4 antibodies ruled out vaccine-induced thrombotic thrombocytopenia. Finally, genetic testing disclosed that all subjects were carriers of at least one pro-thrombotic mutation. Although the presented cases do not allow us to establish any causative relation, they should foster further research to investigate the possible link between COVID-19 vaccination, pro-thrombotic genotypes, and acute cardiovascular events. Full article

(This article belongs to the Special Issue COVID-19 and Cardiac Injury)

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