The intricate interplay between viral infections and cardiovascular complications has become a focal point of research attention. This period of extensive investigation has uncovered substantial connections between various viruses and cardiovascular diseases, including cytomegalovirus (CMV), coxsackievirus, influenza, human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as well as coxsackievirus A and B, enteroviruses, adenovirus, and parvovirus B19. These viruses exert diverse influences on cardiovascular health through multiple pathways, contributing to endothelial dysfunction, causing direct damage to cardiac tissue, and triggering inflammatory responses. The intricate interplay between viral infections and cardiovascular health emphasizes the importance of considering viral pathogens in the context of cardiovascular disease development, clinical management practices, and future research initiatives. This systematic review thoroughly examines the cardiovascular impacts resulting from various viral infections, shedding light on their underlying mechanisms and associated clinical implications. These valuable insights can inform clinical management strategies, preventive measures, and further investigations into the complex connection between viral infections and cardiovascular diseases, highlighting the necessity for ongoing research and vigilance in understanding and managing these pathogen-induced cardiac manifestations.

Viral infections, Cardiovascular complications, Cytomegalovirus

Costa-García M, Ataya M, Moraru M, Vilches C, López-Botet M, Muntasell A. Human cytomegalovirus antigen presentation by HLA-DR+ NKG2C+ adaptive NK cells specifically activates polyfunctional effector memory CD4+ T lymphocytes. Frontiers in immunology. 2019 Apr 3;10:687.

Ji HL, Zhao R, Matalon S, Matthay MA. Elevated plasmin (ogen) as a common risk factor for COVID-19 susceptibility. Physiological reviews. 2020 Apr 3.

Cannata’ A, Artico J, Gentile P, Merlo M, Sinagra G. Myocarditis evolving in cardiomyopathy: when genetics and offending causes work together. European Heart Journal Supplements. 2019 Mar 1;21(Supplement_B):B90-5.

Suresh A, Martens P, Tang WW. Biomarkers for myocarditis and inflammatory cardiomyopathy. Current heart failure reports. 2022 Oct;19(5):346-55.

Elena M Gupalo, O. Y. (2022). Implication of inflammation on Coxsackie virus and Adenovirus receptor expression on cardiomyocytes and the role of platelets in patients with dilated cardiomyopathy. cardiovascular pathology , 107452.

peischard, Stefan et al. (2019) ‘A kidnapping story: How Coxsackievirus B3 and its host cell interact’, Cellular Physiology and Biochemistry, 53(1), pp. 121–140. doi:10.33594/000000125

Fujioka S, K. Y. (2011). Coxsackie B virus infection in idiopathic dilated cardiomyopathy: clinical and pharmacological implications. BioDrugs , 791-799.

Cameron A, Akilan K, Carr D. Infectious mononucleosis-not always a benign condition: a case report of infectious mononucleosis–associated acute acalculous cholecystitis. Canadian Journal of Emergency Medicine. 2019 Jan;21(1):154-6.

Clemens DJ, Ye D, Zhou W, Kim CJ, Pease DR, Navaratnarajah CK, Barkhymer A, Tester DJ, Nelson TJ, Cattaneo R, Schneider JW. SARS-CoV-2 spike protein-mediated cardiomyocyte fusion may contribute to increased arrhythmic risk in COVID-19. Plos one. 2023 Mar 8;18(3):e0282151.

Zhang H, Yin Y, Liu Y, Zou G, Huang H, Qian P, Zhang G, Zhang J. Necroptosis mediated by impaired autophagy flux contributes to adverse ventricular remodeling after myocardial infarction. Biochemical pharmacology. 2020 May 1;175:113915.

Escher F, Kühl U, Lassner D, Schultheiss HP. Cardiomyopathies-The special entity of myocarditis and inflammatory cardiomyopathy. Journal of Cardiology and Cardiovascular Medicine. 2019 Jul 1;4(2):053-70.

Warren-Gash C, Blackburn R, Whitaker H, McMenamin J, Hayward AC. Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. European Respiratory Journal. 2018 Mar 1;51(3).

Cai Z, Greene MI, Zhu Z, Zhang H. Structural features and PF4 functions that occur in heparin-induced thrombocytopenia (HIT) complicated by COVID-19. Antibodies. 2020 Oct 10;9(4):52.

Anderson‐Smits C, Baker ER, Hirji I. Coinfection rates and clinical outcome data for cytomegalovirus and Epstein‐Barr virus in post‐transplant patients: A systematic review of the literature. Transplant Infectious Disease. 2020 Dec;22(6):e13396.

Baritussio A, Cheng CY, Lorenzoni G, Basso C, Rizzo S, De Gaspari M, Fachin F, Giordani AS, Ocagli H, Pontara E, Cattini MG. A machine-learning model for the prognostic role of C-reactive protein in myocarditis. Journal of Clinical Medicine. 2022 Nov 29;11(23):7068.

Rezaee-Zavareh MS, Ajudani R, Khosravi MH, Ramezani-Binabaj M, Rostami Z, Einollahi B. Effect of cytomegalovirus exposure on the atherosclerotic events among kidney-transplanted patients, a systematic review and meta-analysis. Nephro-Urology Monthly. 2018 Jun 23;10(4).

Liu X, Zou Y, Huang D, Lu H. Effect of evidence-based nursing combined with exercise rehabilitation in patients with acute myocardial infarction after percutaneous coronary intervention. American Journal of Translational Research. 2022;14(10):7424.

Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P, Dehmer GJ, Doherty JU, Schoenhagen P, Bashore TM, Bhave NM, Calnon DA. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of .... Journal of the American College of Cardiology. 2019 Feb 5;73(4):488-516.

Chu C, Armenia D, Walworth C, Santoro MM, Shafer RW. Genotypic resistance testing of HIV-1 DNA in peripheral blood mononuclear cells. Clinical Microbiology Reviews. 2022 Dec 21;35(4):e00052-22.

Atkinson TJ, Fudin J. Nonsteroidal antiinflammatory drugs for acute and chronic pain. Physical Medicine and Rehabilitation Clinics. 2020 May 1;31(2):219-31.

García‑Becerril GE, Cruz‑Montalvo AE, De La Cruz MA, Ares MA, Moreno‑Ruiz LA, García‑Chequer AJ, Maldonado‑Bernal C, Gómez‑Jiménez LM, Flores‑García CA, Garrido‑Garduño MH, Cárdenas‑Mondragón MG. Differential expression of coxsackievirus and adenovirus receptor in endomyocardial tissue of patients with myocarditis. Molecular Medicine Reports. 2019 Sep 1;20(3):2189-98.

Xu D, Wang P, Yang J, Qian Q, Li M, Wei L, Xu W. Gr-1+ cells other than Ly6G+ neutrophils limit virus replication and promote myocardial inflammation and fibrosis following coxsackievirus B3 infection of mice. Frontiers in cellular and infection microbiology. 2018 May 15;8:157.

Natarajan E. Plasma Fibinogen Level in Newly Detected Type 2 Diabetes Mellitus Patients in a Tertiary Care Centre (Doctoral dissertation, Madras Medical College, Chennai).

Samadi M, Shirvani H, Rahmati-Ahmadabad S. A study of possible role of exercise and some antioxidant supplements against coronavirus disease 2019 (COVID-19): A cytokines related perspective. Apunts Sports Medicine. 2020 Jul;55(207):115.

Inhibition of DRP1 attenuates mitochondrial damage and myocardial injury in Coxsackievirus B3 induced myocarditis’, Biochemical and Biophysical Research Communications, 484(3), pp. 550–556. doi:10.1016/j.bbrc.2017.01.116

Roos F.J. Marsman, C. R. (2014). Coxsackie and Adenovirus Receptor Is a Modifier of Cardiac Conduction and Arrhythmia Vulnerability in the Setting of Myocardial Ischemia. Journal of the American College of Cardiology, 549-559.

Qamar MU, Rizwan M, Uppal R, Khan AA, Saeed U, Ahmad K, Iqbal MJ, Ali Z, Suleman M. Antimicrobial susceptibility and clinical characteristics of multidrug-resistant polymicrobial infections in Pakistan, a retrospective study 2019-2021. Future Microbiol. 2023 Oct 26. doi: 10.2217/fmb-2023-0110.

Polaris Observatory Collaborators. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023 Oct;8(10):879-907. doi: 10.1016/S2468-1253(23)00197-8.

Piracha ZZ, Saeed U, Ahmed RA, Khan FN, Nasir MI. Global emergence of Langya virus: A serious public health concern. J Glob Health. 2023 Jul 7;13:03034. doi: 10.7189/jogh-13-03034.

National Institute for Health and Care Research Global Health Research Unit on Global Surgery. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg. 2023 Jun 12;110(7):804-817. doi: 10.1093/bjs/znad092.

Saeed U, Piracha ZZ. PIN1 and PIN4 inhibition via parvulin impeders Juglone, PiB, ATRA, 6,7,4'-THIF, KPT6566, and EGCG thwarted hepatitis B virus replication. Front Microbiol. 2023 Jan 25;14:921653. doi: 10.3389/fmicb.2023.921653.

Global Burden of Disease 2021 Health Financing Collaborator Network. Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026. Lancet Glob Health. 2023 Mar;11(3):e385-e413. doi: 10.1016/S2214-109X(23)00007-4.

GBD 2019 Pakistan Collaborators. The state of health in Pakistan and its provinces and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health. 2023 Feb;11(2):e229-e243. doi: 10.1016/S2214-109X(22)00497-1.

Nejadghaderi SA, Moghaddam SS, Azadnajafabad S, Rezaei N, Rezaei N, Tavangar SM, Jamshidi H, Mokdad AH, Naghavi M, Farzadfar F, Larijani B; GBD 2019 NAME Thyroid Cancer Collaborators. Burden of thyroid cancer in North Africa and Middle East 1990-2019. Front Oncol. 2022 Sep 23;12:955358. doi: 10.3389/fonc.2022.955358.

Saeed U, Piracha ZZ, Uppal SR, Waheed Y, Uppal R. SARS-CoV-2 induced hepatic injuries and liver complications. Front Cell Infect Microbiol. 2022 Sep 16;12:726263. doi: 10.3389/fcimb.2022.726263.

GBD 2019 LRI Collaborators. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis. 2022 Nov;22(11):1626-1647. doi: 10.1016/S1473-3099(22)00510-2.

Khalid K, Saeed U, Aljuaid M, Ali MI, Anjum A, Waheed Y. Immunoinformatic Approach to Contrive a Next Generation Multi-Epitope Vaccine Against Achromobacter xylosoxidans Infections. Front Med (Lausanne). 2022 Jul 11;9:902611. doi: 10.3389/fmed.2022.902611.

Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol. 2022 May;7(5):396-415. doi: 10.1016/S2468-1253(21)00472-6.

Saeed U, Piracha ZZ, Kwon H, Kim J, Kalsoom F, Chwae YJ, Park S, Shin HJ, Lee HW, Lim JH, Kim K. The HBV Core Protein and Core Particle Both Bind to the PPiase Par14 and Par17 to Enhance Their Stabilities and HBV Replication. Front Microbiol. 2021 Dec 14;12:795047. doi: 10.3389/fmicb.2021.795047.

Saeed U, Uppal SR, Piracha ZZ, Uppal R. SARS-CoV-2 Spike Antibody Levels Trend among Sinopharm Vaccinated People. Iran J Public Health. 2021 Jul;50(7):1486-1487. doi: 10.18502/ijph.v50i7.6640.

Saeed U, Kim J, Piracha ZZ, Kwon H, Jung J, Chwae YJ, Park S, Shin HJ, Kim K. Parvulin 14 and Parvulin 17 Bind to HBx and cccDNA and Upregulate Hepatitis B Virus Replication from cccDNA to Virion in an HBx-Dependent Manner. J Virol. 2019 Mar 5;93(6):e01840-18. doi: 10.1128/JVI.01840-18.

Piracha ZZ, Kwon H, Saeed U, Kim J, Jung J, Chwae YJ, Park S, Shin HJ, Kim K. Sirtuin 2 Isoform 1 Enhances Hepatitis B Virus RNA Transcription and DNA Synthesis through the AKT/GSK-3β/β-Catenin Signaling Pathway. J Virol. 2018 Oct 12;92(21):e00955-18. doi: 10.1128/JVI.00955-18.

Saeed U, Waheed Y, Ashraf M, Waheed U, Anjum S, Afzal MS. Estimation of Hepatitis B Virus, Hepatitis C Virus, and Different Clinical Parameters in the Thalassemic Population of Capital Twin Cities of Pakistan. Virology (Auckl). 2015 Nov 5;6:11-6. doi: 10.4137/VRT.S31744.

Waheed Y, Saeed U, Anjum S, Afzal MS, Ashraf M. Development of Global Consensus Sequence and Analysis of Highly Conserved Domains of the HCV NS5B Prote in. Hepat Mon. 2012 Sep;12(9):e6142. doi: 10.5812/hepatmon.6142.

Safi SZ, Waheed Y, Sadat J, Solat-Ul-Islam, Salahuddin S, Saeed U, Ashraf M. Molecular study of HCV detection, genotypes and their routes of transmission in North West Frontier Province, Pakistan. Asian Pac J Trop Biomed. 2012 Jul;2(7):532-6. doi: 10.1016/S2221-1691(12)60091-4.

Saeed, U.; Piracha, Z.Z.; Alrokayan, S.; Hussain, T.; Almajhdi, F.N.; Waheed, Y. Immunoinformatics and Evaluation of Peptide Vaccines Derived from Global Hepatitis B Viral HBx and HBc Proteins Critical for Covalently Closed Circular DNA Integrity. Microorganisms 2023, 11, 2826. https://doi.org/10.3390/microorganisms11122826

Saeed, Insaf, PIRACHA, Tariq, Sohail, Abbasi, Mukhtar, Usman, Fida Rana, Gilani, Noor, Noor, Waheed, Wahid, Najmi and Fazal. Crisis Averted: A World United Against the Menace of Multiple Drug-Resistant Superbugs -Pioneering anti-AMR Vaccines, RNA interference, Nanomedicine, CRISPR-based antimicrobials, Bacteriophage Therapies, and Clinical Artificial Intelligence Strategies to Safeguard Global Antimicrobial Arsenal. Front. Microbiol. Sec. Antimicrobials, Resistance and Chemotherapy Volume 14 - 2023 | doi: 10.3389/fmicb.2023.1270018.