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Research progress on the association between viruses and cardiac diseases | Journal of Virology
Viruses have existed long before human history and are ubiquitous in the human environment. Humans acquire viral infections through multiple routes, including the respiratory tract (e.g., inhalation of aerosols or droplets), the gastrointestinal tract (e.g., ingestion of contaminated food or water), contact transmission—either direct (person-to-person) or indirect (via contaminated objects or surfaces)—and vector-borne transmission via arthropods such as mosquitoes and ticks, which is particularly relevant for arboviruses. Importantly, only a subset of viruses exhibit clinically meaningful cardiac tropism or trigger host responses that culminate in cardiovascular injury. Nonetheless, viral infections can affect the cardiovascular system through direct and indirect mechanisms and are increasingly recognized as contributors to an elevated risk of major cardiovascular diseases (1). A substantial body of evidence supports a close association between viral infection and cardiac pathology. Viral illness may precipitate a spectrum of cardiovascular manifestations, including myocarditis, pericarditis, arrhythmias, and acute or chronic heart failure (2–5). Proposed mechanisms include direct injury to cardiomyocytes and other cardiac-resident cells, immune-mediated damage (e.g., exaggerated inflammation, cytokine-driven injury, and autoimmunity), and perturbations of cardiac electrophysiology that promote conduction abnormalities and malignant arrhythmias. In addition, systemic effects of infection—such as endothelial dysfunction, plaque destabilization, and a prothrombotic state—may precipitate acute ischemic events and cerebrovascular complications (6–8). Multiple viral pathogens have been implicated in major adverse cardiovascular events (MACEs). These include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus, HIV, arboviruses (dengue virus [DENV], chikungunya virus [CHIKV], Zika virus [ZIKV]), enteroviruses (coxsackievirus B3 [CVB3]), and human cytomegalovirus (HCMV). Reported MACEs encompass acute myocardial infarction, stroke, heart failure exacerbation or new-onset heart failure, clinically significant arrhythmias, and myocarditis (3, 9–14).
