Cardiovascular changes evidenced in autopsies of patients affected by COVID-19: an integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i13.35112

Keywords:

Autopsy; COVID-19; SARS-CoV-2; Cardiovascular system.

Abstract

Cardiovascular changes related to COVID-19 are being increasingly reported, revealing the need for further investigations. In this context, the autopsy is capable of providing illuminating evidence. Therefore, the objective of this research was to synthesize the main cardiovascular findings of patients affected by COVID-19, based on autopsies. Methodology: A search was carried out in the CINAHAL, Embase, Google Scholar, IBECS, LILACS, MEDLINE, Science Direct, SciELO, Scopus, and Web of Science databases. Results: 29 studies were included, totaling 496 autopsies of men and women (27-94 years), mainly with a history of hypertension, obesity and diabetes. Autopsies revealed thrombi in multiple regions (lung, heart, kidneys, testicles); right ventricular dilation; abundance of megakaryocytes; viral presence in the heart; and myocarditis. Final considerations: COVID-19 has a complex interaction with the cardiovascular system, proving capable of interfering with its homeostasis, with thrombosis being the main pathophysiological event of this disease.

References

Adachi T., Chong J. M., Nakajima N., Sano M., Yamazaki J., Miyamoto I., Nishioka H., Akita H., Sato Y., Kataoka M., Katano H., Tobiume M., Sekizuka T. Itokawa K., Kuroda M., & Suzuki T. (2020). Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan. Emerg Infect Dis, 26(9),2157–61. https://doi.org/10.3201/eid2609.201353.

Alwaqfi N. R., & Ibrahim K. S. (2020). COVID-19: an update and cardiac involvement. J Cardiothorac Surg, 15(1),239. https://doi.org/10.1186/s13019-020-01299-5.

Barton L. M., Duval E. J., Stroberg E., Ghosh S., & Mukhopadhyay S. (2020). COVID-19 Autopsies, Oklahoma, USA. Am J Clin Pathol, 153(6),725-733. https://doi.org/10.1093/ajcp/aqaa062.

Bian X. W., & The COVID-19 Pathology Team. (2020). Autopsy of COVID-19 patients in China. National Science Review, 7(9),1414–1418. https://doi.org/10.1093/nsr/nwaa123.

Borczuk A. C., Salvatore S. P., Seshan S. V., Patel S. S., Bussel J. B., Mostyka M., Elsoukkary S., He B., Vecchio C. D., Fortarezza F., Pezzuto F., Navalesi P., Crisanti A., Fowkes M. E., Bryce C. H., Calabrese F., & Beasley M. B. (2020). COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. Mod Pathol, 33(11),2156-2168. https://doi.org/10.1038/s41379-020-00661-1.

Botelho L. L. R., Cunha C. J. C. A., & Macedo M. (2011). O método da revisão integrativa nos estudos organizacionais. Gestão e Sociedade, 5(11),121-136. https://doi.org/10.21171/ges.v5i11.1220.

Bradley B. T., Maioli H., Johnston R., Chaudhry I., Fink S. L., Xu H., Najafian B., Deutsch G., Lacy J. M., Williams T., Yarid N., & Marshall D. A. (2020). Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series. Lancet, 396(10247),320-332. https://doi.org/10.1016/s0140-6736(20)31305-2.

Bryce C., Grimes Z., Pujadas E., Ahuja S., Beasley M. B., Albrecht R., Hernandez T., Stock A., Zhao Z., Al Rasheed M., Chen J., Li L., Wang D., Corben A., Haines K., Westra W., Umphlett M., Gordon E. R., Reidy J., Petersen B., Salem F., Fiel M., El Jamal M. S., Tsankova M. N., Houldsworth J., Mussa Z., Liu W., Veremis B., Sordillo E., Gitman R. M., Nowak M., Brody R., Harpaz N., Merad M., Gnjatic S., Donnelly R., Seigler P., Keys C., Cameron J., Moultrie I., Washington K., Treatman J., Sebra R., Jhang J., Firpo A., Lednicky J., Paniz-Mondolfi A., Cordon-Cardo C., & Fowkes M. (2020). Pathophysiology of SARS-CoV-2: targeting of endothelial cells renders a complex disease with thrombotic microangiopathy and aberrant immune response. The Mount Sinai COVID-19 autopsy experience. medRxiv. https://doi.org/10.1101/2020.05.18.20099960.

Buja L. M., Wolf D. A., Zhao B., Akkanti B., McDonald M., Lelenwa L., Reilly N., Ottaviani G., Elghetany M. T., Trujillo D. O., Aisenberg G. M., Madjid M., & Kar B. (2020). The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovasc Pathol, 48,107233. https://doi.org/10.1016/j.carpath.2020.107233.

Calabrese F., Pezzuto F., Fortarezza F., Hofman P., Kern I., Panizo A., Thusen J., Timofeev S., Gorkiewicz G., & Lunardi F. (2020). Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists. Virchows Arch, 477(3),359-372. https://doi.org/10.1007/s00428-020-02886-6.

Capotosto L., Nguyen B. L., Ciardi M. R., Mastroianni C., & Vitarelli A. (2020). Heart, COVID-19, and echocardiography. Echocardiography, 37(9),1454-1464. https://doi.org/10.1111/echo.14834.

Carrillo-Esper R., Melgar-Bieberach R. E., Jacinto-Flores S. A., Tapia-Salazar M., & Campa-Mendoza A. N. (2020). Alteraciones de la coagulación en la COVID-19. Cir Cir, 88(6),787-793. https://doi.org/10.24875/ciru.20000416.

Colantuoni A., Martini R., Caprari P., Ballestri M., Capecchi P. L., Gnasso A., Presti R. L., Marcoccia A., Rossi M., & Caimi G. (2020). COVID-19 Sepsis and Microcirculation Dysfunction. Front Physiol, 11,747. https://doi.org/10.3389/fphys.2020.00747.

COVID-19 Autopsy. (2020). The first COVID-19 autopsy in Spain performed during the early stages of the pandemic. Rev Esp Patol, 53(3):182-187. https://doi.org/10.1016/j.patol.2020.05.004.

Dettmeyer R., Lasczkowski G., Weber A., Wolter T., & Kernbach-Wighton G. (2020). Histopathologische Befunde bei therapierter und nichttherapierter SARS-CoV-2-Infektion – Bericht über 3 Autopsien. Rechtsmedizin, 30,336-343. https://doi.org/10.1007/s00194-020-00408-x.

Duarte-Neto A. N., Monteiro R. A. A., Silva L. F. F., Malheiros D. M. A. C., Oliveira E. P., Theodoro-Filho J., Pinho J. R. R., Gomes-Gouvêa M. S., Salles A. P. M., Oliveira I. R. S., Mauad T., Saldiva P. H. N., & Dolhnikoff M. (2020). Pulmonary and systemic involvement in COVID-19 patients assessed with ultrasound-guided minimally invasive autopsy. Histopathology, 77(2),186-197. https://doi.org/10.1111/his.14160.

Edler C., Schröder A. S., Aepfelbacher M., Fitzek A., Heinemann A., Heinrich F., Klein A., Langenwalder F., Lütgehetmann M., Meißner K., Püschel K., Schädler J., Steurer S., Mushumba H., & Sperhake J. P. (2020). Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany. Int J Legal Med, 134(4),1275-1284. https://doi.org/10.1007/s00414-020-02317-w.

Faqihi F., Alharthy A., Alshaya R., Papanikolaou J., Kutsogiannis D. J., Brindley P. G., & Karakitsos D. (2020). Reverse takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: a case-report. BMC Cardiovasc Disord, 20(1),389. https://doi.org/10.1186/s12872-020-01665-0.

Fitzek A., Sperhake J., Edler C., Schröder A. S., Heinemann A., Heinrich F., Ron A., Mushumba H., Lutgehetmann M., & Puschel K. (2020). Evidence for systematic autopsies in COVID-19 positive deceased: Case report of the first German investigated COVID-19 death. Rechtsmedizin, 30,184-189. https://doi.org/10.1007/s00194-020-00401-4.

Flaherty G. T., Hession P, Liew C. H., Lim B. C. W., Leong T. K., Lima V., & Sulaiman L. H. (2020). COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations. Trop Dis Travel Med Vaccines, 6(16),1-13. https://doi.org/10.1186/s40794-020-00118-y.

Fox S. E., Akmatbekov A., Harbert J. L., Li G., Quincy Brown J., & Vander Heide R. S. (2020). Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med, 8(7),681-686. https://doi.org/10.1016/s2213-2600(20)30243-5.

Gawałko M., Kapłon-Cieślicka A., Hohl M., Dobrev D., & Linz D. (2020). COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications. Int J Cardiol Heart Vasc, 30,100631. https://doi.org/10.1016/j.ijcha.

Hanley B., Naresh K. N., Roufosse C, Nicholson A. G., Weir J., Cooke G. S., Thursz M., Manousou P., Corbett R., Goldin R., Al-Sarraj S., Abdolrasouli A., Swann O. C., Baillon L., Penn R., Barclay W. S., Viola P., & Osborn M. (2020). Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe, 1(6),e245-e253. https://doi.org/10.1016/s2666-5247(20)30115-4.

Jung F., Krüger-Genge A., Franke R. P., Hufert F., & Küpper J. H. (2020). COVID-19 and the endothelium. Clin Hemorheol Microcirc, 75(1),7-11. https://doi.org/10.3233/ch-209007.

Kaur S., Tripathi D. M., & Yadav A. (2020). The Enigma of Endothelium in COVID-19. Front Physiol, 11,989. https://doi.org/10.3389/fphys.2020.00989.

Kim J., Volodarskiy A., Sultana R., Pollie M. P., Yum B., Nambiar L., Tafreshi R., Mitlak H. W., RoyChoudhury A., Horn E. M., Hriljac I., Narula N., Kim S., Ndhlovu L., Goyal P., Safford M. M., Shaw L., Devereux R. B., & Weinsaft J. W. (2020). Prognostic Utility of Right Ventricular Remodeling Over Conventional Risk Stratification in Patients With COVID-19. J Am Coll Cardiol, 76(17),1965-1977. https://doi.org/10.1016/j.jacc.2020.08.066.

Klein A., Edler C., Fitzek A., Fröb D., Heinemann A., Meißner K., Mushumba H., Püschel K., Schröder A. S., Sperhake J. P., Ishorst-Witte F., Aepfelbacher M., & Heinrich F. (2020). Der erste COVID-19-Hotspot in einer Hamburger Senioreneinrichtung: Präventionskonzept, Letalität und Obduktionsbefunde. Rechtsmedizin, 30,325-331. https://doi.org/10.1007/s00194-020-00404-1.

Lacy J. M., Brooks E. G., Akers J., Armstrong D., Decker L., Gonzalez A., Humphrey W., Mayer R., Miller M., Perez C., Arango J. A. R., Sathyavagiswaran L., Stroh W., & Utley S. (2020). COVID-19: Postmortem Diagnostic and Biosafety Considerations. Am J Forensic Med Pathol, 41(3),143-151. https://doi.org/10.1097/paf.0000000000000567.

Lindner D., Fitzek A., Bräuninger H., Aleshcheva G., Edler C., Meissner K., Scherschel K., Kirchhof P., Escher F., Schultheiss H. P., Blankenberg S., Püschel K., & Westermann D. (2020). Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases. JAMA Cardiol, 5(11),1281-1285. https://doi.org/10.1001/jamacardio.2020.3551.

Liu Q., Wang R., Qu G., Wang Y., Liu P., Zhu Y., Fei G., Ren L., Zhou Y., & Liu L. (2020). Gross examination report of a COVID-19 death autopsy. Journal of Forensic Medicine, 36(1),21-23. https://doi.org/10.12116/j.issn.1004-5619.2020.01.005.

Lumpuy-Castillo J., Lorenzo-Almorós A., Pello-Lázaro A. M., Sánchez-Ferrer C., Egido J., Tuñón J., Peiro C., & Lorenzo O. (2020). Cardiovascular Damage in COVID-19: Therapeutic Approaches Targeting the Renin-Angiotensin-Aldosterone System. Int J Mol Sci, 21(18),6471. https://doi.org/10.3390/ijms21186471.

Martini R. (2020). The compelling arguments for the need of microvascular investigation in COVID-19 critical patients. Clin Hemorheol Microcirc, 75(1),27-34. https://doi.org/10.3233/ch-200895.

Mendes K. D. S., Silveira R. C. C. P., & Galvão C. M. (2019). Use of the bibliographic reference manager in the selection of primary studies in integrative reviews. Texto Contexto Enfermagem, 28(9),1-13. https://dx.doi.org/10.1590/1980-265X-TCE-2017-0204.

Menter T., Haslbauer J. D., Nienhold R., Savic S., Hopfer H., Deigendesch N., Frank S., Turek D., Willi N., Pargger H., Bassettit S., Leuppi J. D., Cathomas G., Tolnay M., Mertz K. D., & Tzankov A. (2020). Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology, 77(2),198-209. https://doi.org/10.1111/his.14134.

Minhas A. S., Scheel P., Garibaldi B., Liu G., Horton M., Jennings M., Jones S. R., Michos E. D., & Hays A. G. (2020). Takotsubo Syndrome in the Setting of COVID-19. JACC Case Rep, 2(9),1321-1325. https://doi.org/10.1016/j.jaccas.2020.04.023.

Moody W. E., Mahmoud-Elsayed H. M., Senior J., Gul U., Khan-Kheil A. M., Horne S., Banerjee A., Bradlow W. M., Huggett R., Hothi S. S., Shahid M., & Steeds R. P. (2020). Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized with COVID-19 according to Race. CJC Open, 3(1),91-100. https://doi.org/10.1016/j.cjco.2020.09.016.

Mottola F. F., Verde N., Ricciolino R., Di Mauro M. D., Migliaccio M. G., Carfora V., Spiniello G., Coppola N., & Vanvitelli COVID-19 Group. (2020). Cardiovascular System in COVID-19: Simply a Viewer or a Leading Actor?. Life (Basel). 10(9):165. https://doi.org/10.3390/life10090165.

Navarro-Conde P., Monraval P. A., Medina C. M., Sánchez A. J., Teruel J. C. A., Marco J. F., Santos V. P., & Aranda E. M. (2020). Autopsy findings from the first known death from Severe Acute Respiratory Syndrome SARS-CoV-2 in Spain. Rev Esp Patol, 53(3),188-192. https://doi.org/10.1016/j.patol.2020.04.002.

Oprinca G. C., & Muja L. A. (2020). Postmortem examination of three SARS-CoV-2-positive autopsies including histopathologic and immunohistochemical analysis. Int J Legal Med, 135,329-339. https://doi.org/10.1007/s00414-020-02406-w.

Panchal A., Kyvernitakis A., & Biederman R. (2020). An Interesting Case of COVID-19 Induced Reversed Takotsubo Cardiomyopathy and Insight on Cardiac Biomarkers. Cureus, 12(11),e11296. https://doi.org/10.7759/cureus.11296.

Rapkiewicz A. V., Mai X., Carsons S. E., Pittaluga S., Kleiner D. E., Berger J. S., Thomas S., Adler N. M., Charytan D. M., Gasmi B., Hochman J. S., & Reynolds H. R. (2020). Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series. EClinicalMedicine, 24,00434. https://doi.org/10.1016/j.eclinm.2020.100434.

Remmelink M., Mendonça R., D'Haene N., Clercq S., Verocq C., Lebrun L., Lavis P., Racu M. L., Trépant A. L., Maris C., Rorive S., Goffard J. C., Witte O. D., Peluso L., Vincent J. L., Decaestecker C., Taccone F. S., & Salmon I. (2020). Unspecific post-mortem findings despite multiorgan viral spread in COVID-19 patients. Crit Care, 24(1),495. https://doi.org/10.1186/s13054-020-03218-5.

Salerno M., Sessa F., Piscopo A., Montana A., Torrisi M., Patanè F., Murabito P., Volti G. L., & Pomora C. (2020). No Autopsies on COVID-19 Deaths: A Missed Opportunity and the Lockdown of Science. J Clin Med, 9(5),1472. https://doi.org/10.3390/jcm9051472.

Sawalha K., Abozenah M., Kadado A. J., Battisha A., Al-Akchar M., Salerno C., Montfort J. H., & Islam A. M. (2020). Systematic review of COVID-19 related myocarditis: Insights on management and outcome. Cardiovasc Revasc Med, 23,107-113. https://doi.org/10.1016/j.carrev.2020.08.028.

Schaller T., Hirschbühl K., Burkhardt K., Braun G., Trepel M., Märkl B., & Claus R. (2020). Postmortem Examination of Patients With COVID-19. JAMA, 323(24),2518-2520. https://doi.org/10.1001/jama.2020.8907.

Schub D., Klemis V., Schneitler S., Mihm J., Lepper P. M., Wilkens H., Bals R., Eichler H., Gartner B. C., Becker S. L., Sester U., Sester M., & Schmidt T. (2020). High levels of SARS-CoV-2 specific T-cells with restricted functionality in severe course of COVID-19. JCI Insight. 5(20),e142167. https://doi.org/10.1172/jci.insight.142167.

Sekhawat V., Green A., & Mahadeva U. (2020). COVID-19 autopsies: conclusions from international studies. Diagn Histopathol, 27(3), 103-107. https://doi.org/10.1016/j.mpdhp.2020.11.008.

Sessa F., Bertozzi G., Cipolloni L., Baldari B., Cantatore S., D'Errico S., Mizio G. D., Asmundo A., Castorina S., Salerno M., & Pomara C. (2020). Clinical-Forensic Autopsy Findings to Defeat COVID-19 Disease: A Literature Review. J Clin Med, 9(7),2026. https://doi.org/10.3390/jcm9072026.

Siripanthong B., Nazarian S., Muser D., Deo R., Santangeli P., Khanji M. Y., Cooper Jr. L. T., & Chahal C. A. A. (2020). Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm, 17(9),1463-1471. https://doi.org/10.1016/j.hrthm.2020.05.001.

Sperhake J. P. (2020). Autopsies of COVID-19 deceased? Absolutely!. Leg Med (Tokyo), 47,101769. https://doi.org/10.1016/j.legalmed.2020.101769.

Ssentongo P., Ssentongo A. E., Heilbrunn E. S., Ba D. M., & Chinchilli V. M. (2020). Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS One, 15(8),0238215. https://doi.org/10.1371/journal.pone.0238215.

Thachil J., & Lisman T. (2020). Pulmonary Megakaryocytes in Coronavirus Disease 2019 (COVID-19): Roles in Thrombi and Fibrosis. Semin Thromb Hemost, 46(7),831-834. https://doi.org/10.1055/s-0040-1714274.

Titi L., Magnanimi E., Mancone M., Infusino F., Coppola G., Del Nonno F., Colombo D., Nardacci R., Falasca L., Amati G., Tarsitano M. G., Merlino L., Fedele F., & Pugliese F. (2020). Fatal Takotsubo syndrome in critical COVID-19 related pneumonia. Cardiovasc Pathol, 51,107314. https://doi.org/10.1016/j.carpath.2020.107314.

Tombolini A., & Scendoni R. (2020). SARS-CoV-2-related deaths in routine forensic autopsy practice: histopathological patterns. Int J Legal Med, 134(6),2205-2208. https://doi.org/10.1007/s00414-020-02354-5.

Valdivia-Mazeyra M. F., Salas C., Nieves-Alonso J. M., Martín-Fragueiro L., Bárcena C., Muñoz-Hernández P., Villar-Zarra K., Martín-López J., Ramasco-Rueda F., Fraga J., & Jiménez-Heffernan J. A. (2020). Increased number of pulmonary megakaryocytes in COVID-19 patients with diffuse alveolar damage: an autopsy study with clinical correlation and review of the literature. Virchows Arch, 478,487-496. https://doi.org/10.1007/s00428-020-02926-1.

Wichmann D., Sperhake J. P., Lütgehetmann M., Steurer S., Edler C., Heinemann A., Heinrich F., Mushumba H., Kniep I., Schroder A. S., Burdelski C., Heer G., Nierhaus A., Frings D., Pfefferle S., Becker H., Bredereke-Wiedling H., Weerth A., Paschen H. R., Eggers S. S., Stang A., Schmiedel S., Bokemeyer C., Addo M. M., Aepfelbacher M., Puschel K., & Kluge S. (2020). Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann Intern Med, 173(4).268-277. https://doi.org/10.7326/m20-2003.

Yan L., Mir M., Sanchez P., Beg M., Peters J., Enriquez O., & Gilbert A. (2020). COVID-19 in a Hispanic Woman. Arch Pathol Lab Med, 144(9),1041-1047. https://doi.org/10.5858/arpa.2020-0217-sa.

Xiaohong Y., Tingyuan L., Zhicheng H. Yifang P., Huawen L., Shicang Y., Huaming M., Lihua W., Huarong Z., Wenjuan F., Tao L., Feng L., Qiaonan G., Cong C., Hualiang X., Haitao G., Shuang L., Dongfang X., Yu S., Guangqiang P., Qingrui L., Xia H., Yong C., Xizhao L., Wei T., Pengfei P., Xuequan H., Yanqing D., & Xiuwu B. (2020). A pathological report of three COVID-19 cases by minimal invasive autopsies. Chinese Journal of Pathology, 49(5),411-417. https://doi.org/10.3760/cma.j.cn112151-20200312-00193.

Youd E., & Moore L. (2020). COVID-19 autopsy in people who died in community settings: the first series. J Clin Pathol, 73(12),840-844. https://doi.org/10.1136/jclinpath-2020-206710.

Downloads

Published

01/10/2022

How to Cite

SILVA, J. L. da .; GALDINO, D. M. da C. .; ARAÚJO, B. T. S. de .; COLAÇO, E. O. .; LEITE, J. C. . Cardiovascular changes evidenced in autopsies of patients affected by COVID-19: an integrative review. Research, Society and Development, [S. l.], v. 11, n. 13, p. e143111335112, 2022. DOI: 10.33448/rsd-v11i13.35112. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/35112. Acesso em: 24 dec. 2024.

Issue

Vol. 11 No. 13

Section

Review Article

License

Copyright (c) 2022 Josicléia Leôncio da Silva; Diogo Magalhães da Costa Galdino; Bruna Thays Santana de Araújo; Elisabete Oliveira Colaço; Jéssica Costa Leite

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.