Persistent viral infections and their role in heart disease

Abstract

Viral infections are the culprit of many diseases, including inflammation of the heart muscle, known as myocarditis. Acute myocarditis cases have been described in scientific literature, and viruses, such as parvovirus B19, coxsackievirus B3, or more recently, SARS-CoV-2, were the direct cause of cardiac inflammation. If not treated, myocarditis could progress to dilated cardiomyopathy, which permanently impairs the heart and limits a person’s lifespan. Accumulated evidence suggests that certain viruses may persist in cardiac tissue after the initial infection, which could open up the door to reactivation under favorable conditions. Whether this chronic infection contributes to, or initiates, cardiac damage over time, remains a pressing issue in the field of virus-induced heart pathology, and it is directly tied to patients’ treatment. Previously, large case studies found that a few viruses: parvovirus B19, coxsackievirus, adenovirus, human herpesvirus 6, cytomegalovirus and Epstein–Barr virus, are most commonly found in human endomyocardial biopsy samples derived from patients experiencing cardiac inflammation, or dilated cardiomyopathy. SARS-CoV-2 infection has also been shown to have cardiovascular consequences. This review examines the role of viral persistence in cardiac inflammation and heart disease, and discusses its implications for patients’ outcomes.

RNA sequencing provides novel insights into the pathogenesis of naturally occurring myxomatous mitral valve disease stage B1 in beagle dogs

“…Type I IFNs play a central role in immune responses against viral and microbial infections [ 61 , 62 ]. Viruses can directly damage the heart by infecting and rupturing host cells and can cause indirect damage by stimulating pro-inflammatory cytokine production and attracting immune cells [ 63 , 64 ]. Most genes linked to antiviral processes showed higher expression in the NC group than in the MMVD group, suggesting that the MMVD group may be more susceptible to viruses, potentially leading to an inflammatory environment in the heart [ 65 ].…”

The Masquerading Myocarditis: A Case of Late Recurrence of Acute Myocarditis Presenting as “Peripartum Cardiomyopathy”

“…Another postulated mechanism is the reactivation of a latent viral infection. Several viruses known to cause myocarditis, such as adenovirus, enterovirus/coxsackievirus, parvovirus B19, herpes simplex virus, and cytomegalovirus infection, may persist in a latent form or as chronic infections following the initial infection [ 14 ]. It is also reasonably possible that one gets repeated exposure to a causative organism, leading to the recurrence of myocarditis.…”

Global landscape of coxsackieviruses in human health

“…These events are associated with high morbidity and death. Although infectious (bacteria, protozoa, fungi) and non-infectious (drugs, poisons) agents can cause inflammatory cardiomyopathy (myocarditis), viruses have been identified as the most common etiological agents ( Badrinath et al, 2022 ; Tschöpe et al, 2021 ). Among the viruses, enteroviruses, notably coxsackieviruses, are typically associated with cardiovascular manifestations, with proteins/RNA viral detected rates ranging from 20 to 40 % of myocarditis or cardiomyopathy cases in children and young adults ( Leonard, 2004 ; Kim et al, 2001 ).…”