一项来自 RECOVER 项目的多机构尸检队列研究证实，在患有心脏症状的长新冠患者中，SARS-CoV-2 病毒可在其心脏组织中持续存在并发生复制 [1]。该研究通过检测左心室组织中的病毒反向链（viral reverse transcript），确立了病毒复制与心脏结构改变及免疫反应之间的关联 [1]。
研究对象共为 74 名感染后超过 60 天的死者，其中 11 例检测到 SARS-CoV-2 反向链阳性（V+），其余 63 例未检测到该信号（V-）[1]。在 V+ 病例中，82% 出现了心脏长新冠症状，这一比例显著高于 V- 病例的 37%，统计学差异为 p=0.0075 [1]。此外，从最后一次阳性拭子到尸检的中位间隔时间显示，V+ 病例为 299 天，短于 V- 病例的 522 天 [1]。
解剖学分析表明，V+ 心脏表现出更高的心重与左心室壁厚度比（平均值为 437 g/cm²对比 V- 组的 340 g/cm²），且出现左心室扩张的频率更高（64% vs 24%）[1]。差异基因表达分析进一步揭示，有 44 个涉及炎症和宿主反应的基因表达发生显著改变，其中包括干扰素调节因子 4（IRF4）等关键指标 [1]。
A multi-institutional study from the RECOVER project autopsy cohort has found that SARS-CoV-2 virus persists and replicates within heart tissue among deceased individuals with long COVID symptoms. The research confirmed this replication by detecting viral reverse transcription chains in left ventricular tissue, establishing a link between viral activity, structural cardiac changes, and immune responses [1].
The study analyzed 74 deceased subjects infected more than 60 days prior to death; SARS-CoV-2 reverse transcription was detected (designated V+) in 11 cases but not found (V-) in the remaining 63 cases [1]. Among those with viral detection, 82% exhibited long COVID heart symptoms, a rate significantly higher than the 37% observed in non-viral cases (p=0.0075) [1]. The median interval between a patient's last positive swab and autopsy was shorter for V+ cases at 299 days compared to 522 days for V- cases [1].
Cardiac structural differences were pronounced in the viral-positive group, which showed a higher mean ratio of heart weight to left ventricular wall thickness (437 vs. 340 g/cm) and more frequent instances of left ventricular dilation (64% vs. 24%) [1]. Gene expression analysis revealed significant alterations in 44 genes involved in inflammation and host response, with particular emphasis on interferon regulatory factor 4 (IRF4) [1].