{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:43:31Z","timestamp":1785437011745,"version":"3.56.0"},"reference-count":82,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Post-acute sequelae of SARS-CoV-2 infection (PASC) extend well beyond the acute respiratory phase, with accumulating virological evidence that SARS-CoV-2 RNA, viral antigens, and proteolytic fragments may persist in cardiovascular and other extrapulmonary tissues, although the extent to which such detection represents replication-competent reservoirs versus residual viral material with uncertain pathological relevance remains under active investigation. Sudden cardiac death (SCD) and fatal pulmonary thromboembolism (PTE) have emerged as forensically and epidemiologically significant outcomes in individuals with prior infection, situated at the intersection of microbiology, public health, and forensic medicine. To synthesize current evidence on the virological mechanisms by which SARS-CoV-2 may contribute to post-acute sudden cardiac death (SCD) and pulmonary thromboembolism (PTE), the population-level epidemiology of these outcomes, and their implications for public health surveillance and forensic practice, we conducted a narrative review of PubMed (MEDLINE), Scopus, and Web of Science Core Collection. The search covered publications from January 2020 to December 2025 and focused on SARS-CoV-2 cellular tropism and tissue persistence, immune-mediated and thromboinflammatory mechanisms, excess cardiovascular and thromboembolic mortality, and autopsy-based pathological findings. After de-duplication of 1837 initially identified records (412 duplicates removed) and screening of 1425 unique records, 78 studies were retained for final synthesis based on virological, epidemiological, and forensic relevance. SARS-CoV-2 enters cardiomyocytes, pericytes, and vascular endothelial cells through ACE2-dependent mechanisms, with cathepsin L compensating for the limited cardiac expression of TMPRSS2. Viral RNA and antigen have been detected in cardiovascular and other extrapulmonary tissues months after symptom onset in selected autopsy series, although persistent detection of viral components does not necessarily indicate ongoing productive infection or direct tissue injury. Endothelial dysfunction, neutrophil extracellular trap (NET) formation, complement activation, and persistent thromboinflammation have been proposed as plausible mechanistic substrates for arrhythmogenic remodelling and thromboembolic events, although definitive causal pathways remain incompletely understood. Population-based studies document persistent excess cardiovascular mortality across multiple jurisdictions, with hazard ratios for pulmonary embolism remaining elevated months after acute infection, particularly in unvaccinated individuals. Autopsy series identify mixed pathological patterns including focal lymphocytic infiltrates, microvascular thrombosis, contraction-band necrosis, and cardiomyocyte vacuolation, although fulminant lymphocytic myocarditis fulfilling Dallas criteria remains uncommon. A microbiology-informed framework uniting tissue-based viral detection, standardized cardiac and pulmonary sampling protocols, and prospective post-mortem registries is needed to better characterize the potential contribution of SARS-CoV-2 to post-acute cardiovascular mortality and to support cause-of-death certification, public health surveillance, and medicolegal practice in the post-pandemic era. Many of the proposed mechanisms remain under active investigation, and definitive causal relationships between viral persistence and adverse cardiovascular outcomes have not yet been conclusively established.<\/jats:p>","DOI":"10.3390\/microorganisms14061256","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:38:42Z","timestamp":1780411122000},"page":"1256","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["SARS-CoV-2 Persistence and Cardiovascular Sequelae in the Post-COVID Era: A Public Health Microbiology Perspective on Sudden Cardiac Death and Pulmonary Thromboembolism"],"prefix":"10.3390","volume":"14","author":[{"given":"Cris Virgiliu","family":"Precup","sequence":"first","affiliation":[{"name":"Department of Biology and Life Sciences, Faculty of Medicine, \u201cVasile Goldi\u0219\u201d Western University of Arad, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4951-1702","authenticated-orcid":false,"given":"Diana-Maria","family":"Mateescu","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Enache","sequence":"additional","affiliation":[{"name":"Department of Legal Medicine, Timi\u0219oara Institute of Legal Medicine, 300041 Timi\u0219oara, Romania"},{"name":"Ethics and Human Identification Research Center, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timi\u0219oara, Romania"},{"name":"Discipline of Forensic Medicine, Bioethics, Deontology, and Medical Law, Department of Neuroscience, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camelia Liana","family":"Buhas","sequence":"additional","affiliation":[{"name":"Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3896-9599","authenticated-orcid":false,"given":"Camelia-Oana","family":"Muresan","sequence":"additional","affiliation":[{"name":"Department of Legal Medicine, Timi\u0219oara Institute of Legal Medicine, 300041 Timi\u0219oara, Romania"},{"name":"Ethics and Human Identification Research Center, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timi\u0219oara, Romania"},{"name":"Discipline of Forensic Medicine, Bioethics, Deontology, and Medical Law, Department of Neuroscience, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, May 01). COVID-19 Dashboard, Available online: https:\/\/covid19.who.int\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/s41579-022-00846-2","article-title":"Long COVID: Major findings, mechanisms and recommendations","volume":"21","author":"Davis","year":"2023","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.amepre.2023.11.009","article-title":"Trends in cardiovascular disease mortality rates and excess deaths, 2010\u20132022","volume":"66","author":"Woodruff","year":"2024","journal-title":"Am. J. Prev. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.cell.2020.02.052","article-title":"SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor","volume":"181","author":"Hoffmann","year":"2020","journal-title":"Cell"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1038\/s41586-020-2797-4","article-title":"Cells of the adult human heart","volume":"588","author":"Maatz","year":"2020","journal-title":"Nature"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1186\/s12967-023-04224-1","article-title":"Single-cell analysis of adult human heart across healthy and cardiovascular disease patients reveals the cellular landscape underlying SARS-CoV-2 invasion of myocardial tissue through ACE2","volume":"21","author":"Chen","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1038\/s41586-022-05542-y","article-title":"SARS-CoV-2 infection and persistence in the human body and brain at autopsy","volume":"612","author":"Stein","year":"2022","journal-title":"Nature"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1038\/s41590-023-01601-2","article-title":"SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC)","volume":"24","author":"Proal","year":"2023","journal-title":"Nat. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1016\/j.jtha.2023.04.039","article-title":"Thromboinflammation in long COVID\u2014The elusive key to postinfection sequelae?","volume":"21","author":"Nicolai","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s12933-021-01359-7","article-title":"Persistent clotting protein pathology in long COVID\/post-acute sequelae of COVID-19 is accompanied by increased levels of antiplasmin","volume":"20","author":"Pretorius","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1038\/s44161-023-00220-2","article-title":"Excess cardiovascular mortality across multiple COVID-19 waves in the United States from March 2020 to March 2022","volume":"2","author":"Han","year":"2023","journal-title":"Nat. Cardiovasc. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e655","DOI":"10.1002\/mco2.655","article-title":"Risk of pulmonary embolism and deep vein thrombosis following COVID-19: A nationwide cohort study","volume":"5","author":"Kim","year":"2024","journal-title":"MedComm"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100284","DOI":"10.1016\/j.rpth.2023.100284","article-title":"Pulmonary embolism and deep venous thrombosis after COVID-19: Long-term risk in a population-based cohort study","volume":"7","author":"Lindgren","year":"2023","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1038\/s41591-022-01840-0","article-title":"Long COVID after breakthrough SARS-CoV-2 infection","volume":"28","author":"Bowe","year":"2022","journal-title":"Nat. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1038\/s41591-023-02521-2","article-title":"Postacute sequelae of COVID-19 at 2 years","volume":"29","author":"Bowe","year":"2023","journal-title":"Nat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s10753-020-01337-3","article-title":"Inflammation triggered by SARS-CoV-2 and ACE2 augment drives multiple organ failure of severe COVID-19: Molecular mechanisms and implications","volume":"44","author":"Iwasaki","year":"2021","journal-title":"Inflammation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s12024-020-00310-8","article-title":"Autopsy findings in COVID-19-related deaths: A literature review","volume":"17","author":"Maiese","year":"2021","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lisman, D., Zieli\u0144ska, G., Drath, J., \u0141aszczewska, A., Savochka, I., Parafiniuk, M., and Ossowski, A. (2023). Molecular diagnosis of COVID-19 sudden and unexplained deaths: The insidious face of the pandemic. Diagnostics, 13.","DOI":"10.3390\/diagnostics13182980"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1038\/s41591-020-0868-6","article-title":"SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes","volume":"26","author":"Sungnak","year":"2020","journal-title":"Nat. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"eabf7872","DOI":"10.1126\/scitranslmed.abf7872","article-title":"SARS-CoV-2 infection of human iPSC-derived cardiac cells reflects cytopathic features in hearts of patients with COVID-19","volume":"13","author":"Kang","year":"2021","journal-title":"Sci. Transl. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.stemcr.2021.02.008","article-title":"SARS-CoV-2 infects human pluripotent stem cell-derived cardiomyocytes, impairing electrical and mechanical function","volume":"16","author":"Marchiano","year":"2021","journal-title":"Stem Cell Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45023","DOI":"10.1021\/acsomega.2c05376","article-title":"Predicting in vitro and in vivo anti-SARS-CoV-2 activities of antivirals by intracellular bioavailability and biochemical activity","volume":"7","author":"Zhang","year":"2022","journal-title":"ACS Omega"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1056\/NEJMoa2015432","article-title":"Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19","volume":"383","author":"Ackermann","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Dmytrenko, O., and Lavine, K.J. (2022). Cardiovascular tropism and sequelae of SARS-CoV-2 infection. Viruses, 14.","DOI":"10.3390\/v14061137"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e487","DOI":"10.1093\/cid\/ciac722","article-title":"Persistent circulating severe acute respiratory syndrome coronavirus 2 spike is associated with post-acute coronavirus disease 2019 sequelae","volume":"76","author":"Swank","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100663","DOI":"10.1016\/j.xcrm.2022.100663","article-title":"The IL-1\u03b2, IL-6, and TNF cytokine triad is associated with post-acute sequelae of COVID-19","volume":"3","author":"Willscher","year":"2022","journal-title":"Cell Rep. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Tejerina, F., Catalan, P., Rodriguez-Grande, C., Adan, J., Rodriguez-Gonzalez, C., Mu\u00f1oz, P., Aldamiz, T., Diez, C., Perez, L., and Fanciulli, C. (2022). Post-COVID-19 syndrome: SARS-CoV-2 RNA detection in plasma, stool, and urine in patients with persistent symptoms after COVID-19. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07153-4"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1053\/j.gastro.2022.04.037","article-title":"Postacute COVID-19 is characterized by gut viral antigen persistence in inflammatory bowel diseases","volume":"163","author":"Zollner","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1016\/j.chom.2024.11.007","article-title":"Persistence of spike protein at the skull-meninges-brain axis may contribute to the neurological sequelae of COVID-19","volume":"32","author":"Rong","year":"2024","journal-title":"Cell Host Microbe"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1038\/s41586-023-06651-y","article-title":"Distinguishing features of long COVID identified through immune profiling","volume":"623","author":"Klein","year":"2023","journal-title":"Nature"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.ijbiomac.2021.10.112","article-title":"SARS-CoV-2 spike protein causes blood coagulation and thrombosis by competitive binding to heparan sulfate","volume":"193","author":"Zheng","year":"2021","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1042\/BCJ20220016","article-title":"A central role for amyloid fibrin microclots in long COVID\/PASC: Origins and therapeutic implications","volume":"479","author":"Kell","year":"2022","journal-title":"Biochem. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e2300644120","DOI":"10.1073\/pnas.2300644120","article-title":"Viral afterlife: SARS-CoV-2 as a reservoir of immunomimetic peptides that reassemble into proinflammatory supramolecular complexes","volume":"121","author":"Zhang","year":"2024","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1001\/jamacardio.2020.3551","article-title":"Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases","volume":"5","author":"Lindner","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3827","DOI":"10.1093\/eurheartj\/ehaa664","article-title":"Pathological features of COVID-19-associated myocardial injury: A multicentre cardiovascular pathology study","volume":"41","author":"Basso","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"107300","DOI":"10.1016\/j.carpath.2020.107300","article-title":"Myocarditis is rare in COVID-19 autopsies: Cardiovascular findings across 277 postmortem examinations","volume":"50","author":"Halushka","year":"2021","journal-title":"Cardiovasc. Pathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1093\/eurheartj\/eht210","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases","volume":"34","author":"Caforio","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Falleti, J., Orabona, P., Municin\u00f2, M., Castellaro, G., Fusco, G., and Mansueto, G. (2024). An update on myocarditis in forensic pathology. Diagnostics, 14.","DOI":"10.3390\/diagnostics14070760"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ambrosino, P., Calcaterra, I., Molino, A., Moretta, P., Lupoli, R., Spedicato, G.A., Papa, A., Motta, A., Maniscalco, M., and Di Minno, M.N.D. (2021). Persistent endothelial dysfunction in post-acute COVID-19 syndrome: A case-control study. Biomedicines, 9.","DOI":"10.3390\/biomedicines9080957"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1093\/cvr\/cvaa230","article-title":"Endothelial dysfunction in COVID-19: A position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science","volume":"116","author":"Evans","year":"2020","journal-title":"Cardiovasc. Res."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Charfeddine, S., Ibn Hadj Amor, H., Jdidi, J., Torjmen, S., Kraiem, S., Hammami, R., Bahloul, A., Kallel, N., Moussa, N., and Touil, I. (2021). Long COVID-19 syndrome: Is it related to microcirculation and endothelial dysfunction?. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.745758"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1038\/s44161-024-00543-8","article-title":"CCL2-mediated endothelial injury drives cardiac dysfunction in long COVID","volume":"3","author":"Thomas","year":"2024","journal-title":"Nat. Cardiovasc. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1016\/j.ajpath.2025.06.005","article-title":"The substructure of the endothelial glycocalyx in rat aorta and its interaction with the low-density lipoproteins","volume":"195","author":"Kang","year":"2025","journal-title":"Am. J. Pathol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e138999","DOI":"10.1172\/jci.insight.138999","article-title":"Neutrophil extracellular traps in COVID-19","volume":"5","author":"Zuo","year":"2020","journal-title":"JCI Insight"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1182\/blood.2020007008","article-title":"Neutrophil extracellular traps contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome","volume":"136","author":"Middleton","year":"2020","journal-title":"Blood"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1177\/1358863X231224383","article-title":"Dysregulated platelet function in patients with postacute sequelae of COVID-19","volume":"29","author":"Aggarwal","year":"2024","journal-title":"Vasc. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1182\/blood.2020007214","article-title":"Platelet gene expression and function in patients with COVID-19","volume":"136","author":"Manne","year":"2020","journal-title":"Blood"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1161\/CIRCRESAHA.124.325645","article-title":"NR4A1 acts as a novel regulator of platelet activation and thrombus formation","volume":"136","author":"Liu","year":"2025","journal-title":"Circ. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.trsl.2020.04.007","article-title":"Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases","volume":"220","author":"Magro","year":"2020","journal-title":"Transl. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s12933-022-01579-5","article-title":"Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with long COVID\/PASC","volume":"21","author":"Pretorius","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1111\/jth.14850","article-title":"Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis","volume":"18","author":"Panigada","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1080\/23744235.2021.1924397","article-title":"Long COVID or post-COVID-19 syndrome: Putative pathophysiology, risk factors, and treatments","volume":"53","author":"Yong","year":"2021","journal-title":"Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1056\/NEJMc2007575","article-title":"Coagulopathy and antiphospholipid antibodies in patients with COVID-19","volume":"382","author":"Zhang","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.jare.2025.05.013","article-title":"SARS-CoV-2 damages cardiomyocyte mitochondria and implicates long COVID-associated cardiovascular manifestations","volume":"80","author":"Che","year":"2025","journal-title":"J. Adv. Res."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Shang, C., Liu, Z., Zhu, Y., Lu, J., Ge, C., Zhang, C., Li, N., Jin, N., Li, Y., and Tian, M. (2022). SARS-CoV-2 causes mitochondrial dysfunction and mitophagy impairment. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.780768"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e2512919","DOI":"10.1001\/jamanetworkopen.2025.12919","article-title":"Postpandemic cardiac mortality rates","volume":"8","author":"Wasfy","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1007\/s12024-024-00922-4","article-title":"Autopsy characteristics of deaths due to pulmonary thromboembolism in northern and western Denmark: A 10-year retrospective study","volume":"21","author":"Christensen","year":"2025","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e437","DOI":"10.1016\/S2468-2667(20)30117-1","article-title":"Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: A population-based, observational study","volume":"5","author":"Marijon","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Song, S., Guo, C., Wu, R., Zhao, H., Li, Q., Dou, J.-H., Guo, F.-S., and Wei, J. (2024). Impact of the COVID-19 pandemic on cardiovascular mortality and contrast analysis within subgroups. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1279890"},{"key":"ref_63","unstructured":"Zipes, D.P., Libby, P., Bonow, R.O., Mann, D.L., and Tomaselli, G.F. (2019). Cardiac arrest and sudden cardiac death. Braunwald\u2019s Heart Disease: A Textbook of Cardiovascular Medicine, Elsevier. [11th ed.]."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"euae128","DOI":"10.1093\/europace\/euae128","article-title":"Autopsy examination in sudden cardiac death: A current perspective on behalf of the Association for European Cardiovascular Pathology","volume":"26","author":"Lynge","year":"2024","journal-title":"Europace"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s00428-017-2221-0","article-title":"Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology","volume":"471","author":"Basso","year":"2017","journal-title":"Virchows Arch."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1161\/CIRCULATIONAHA.120.051828","article-title":"Microthrombi as a major cause of cardiac injury in COVID-19: A pathologic study","volume":"143","author":"Pellegrini","year":"2021","journal-title":"Circulation"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e20564","DOI":"10.1016\/j.heliyon.2023.e20564","article-title":"Common pathological findings in the heart in COVID-19-related sudden death cases: An autopsy case series","volume":"9","author":"Kyuno","year":"2023","journal-title":"Heliyon"},{"key":"ref_68","first-page":"e42444","article-title":"Myocarditis and myocardial injury in long COVID syndrome: A comprehensive review of the literature","volume":"15","author":"Paruchuri","year":"2023","journal-title":"Cureus"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1161\/CIRCULATIONAHA.120.050754","article-title":"COVID-19-associated nonocclusive fibrin microthrombi in the heart","volume":"143","author":"Bois","year":"2021","journal-title":"Circulation"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"107476","DOI":"10.1016\/j.carpath.2022.107476","article-title":"Myocarditis in the forensic setting","volume":"62","author":"Oyarzun","year":"2023","journal-title":"Cardiovasc. Pathol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"nwac104","DOI":"10.1093\/nsr\/nwac104","article-title":"A CRISPR\/Cas12a-empowered surface plasmon resonance platform for rapid and specific diagnosis of the Omicron variant of SARS-CoV-2","volume":"9","author":"Chen","year":"2022","journal-title":"Natl. Sci. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Campuzano, O., Sarquella-Brugada, G., Fernandez-Falgueras, A., Coll, M., Iglesias, A., Ferrer-Costa, C., Cesar, S., Arbelo, E., Brugada, J., and Brugada, R. (2023). Molecular autopsy: Twenty years of post-mortem diagnosis in sudden cardiac death. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1118585"},{"key":"ref_73","first-page":"209","article-title":"Medicolegal evaluation of fatal pulmonary thromboembolism","volume":"Volume 3","author":"Tsokos","year":"2005","journal-title":"Forensic Pathology Reviews"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1007\/s12024-025-00976-y","article-title":"Cadaver clots: A systematic review of the literature","volume":"21","author":"Molina","year":"2025","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_75","first-page":"40","article-title":"Can forensic pathologists diagnose pulmonary thromboembolism on postmortem computed tomography pulmonary angiography?","volume":"35","author":"Garland","year":"2014","journal-title":"Am. J. Forensic Med. Pathol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"350","DOI":"10.7326\/M20-2566","article-title":"Pulmonary arterial thrombosis in COVID-19 with fatal outcome: Results from a prospective, single-center, clinicopathologic case series","volume":"173","author":"Lax","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1038\/s41379-021-00793-y","article-title":"Pathophysiology of SARS-CoV-2: The Mount Sinai COVID-19 autopsy experience","volume":"34","author":"Bryce","year":"2021","journal-title":"Mod. Pathol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s00414-020-02317-w","article-title":"Dying with SARS-CoV-2 infection\u2014An autopsy study of the first consecutive 80 cases in Hamburg, Germany","volume":"134","author":"Edler","year":"2020","journal-title":"Int. J. Leg. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M20-2003","article-title":"Autopsy findings and venous thromboembolism in patients with COVID-19: A prospective cohort study","volume":"173","author":"Wichmann","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_80","unstructured":"World Health Organization (2025, October 30). ICD-11 for Mortality and Morbidity Statistics: Coding for COVID-19 and Post-COVID-19 Condition, Available online: https:\/\/icd.who.int\/."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1177\/0025802413496408","article-title":"Lethal pulmonary thromboembolism: An autopsy-based study on a rare but legally relevant event","volume":"54","author":"Mobilia","year":"2014","journal-title":"Med. Sci. Law"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.legalmed.2007.09.003","article-title":"Pulmonary thromboembolism: Overview and update from medicolegal aspects","volume":"10","author":"Ro","year":"2008","journal-title":"Leg. Med."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/6\/1256\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:54:30Z","timestamp":1780412070000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/6\/1256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":82,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["microorganisms14061256"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14061256","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]}}}