Cardiac Complications of Infections Due to Respiratory Syncytial Virus and Human Metapneumovirus: A Systematic Review and Pooled Analysis of Clinical Features.
7 affiliations
- 1Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy.
- 2Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, "G. D'Alessandro", University of Palermo, AOUP P. Giaccone, 90127 Palermo, Italy.
- 3Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, AOUP P. Giaccone, 90127 Palermo, Italy.
- 4Department of Otorhinolaryngology, ASUIT (Azienda Sanitaria Universitaria Integrata del Trentino) Trento, 38122 Trento, Italy.
- 5SCDU Pediatria e Neonatologia, Ospedale Degli Infermi, Ponderano (BI), Dipartimento Materno-Infantile ASLBI, Università di Torino, 10124 Torino, Italy.
- 6Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
- 7Department of Medicine and Diagnostics, AUSL (Azienda Unità Sanitaria Locale) di Parma, 43100 Parma, Italy.
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are major causes of respiratory tract infections across different age groups. Although primarily regarded as respiratory pathogens, both viruses have been associated with cardiac complications, whose clinical spectrum remains incompletely characterized. We systematically reviewed published cases of RSV- and hMPV-associated cardiac involvement and compared their clinical characteristics and outcomes. PubMed, Scopus, and EMBASE were systematically searched for reports describing cardiac complications associated with laboratory-confirmed RSV or hMPV infection. Individual patient data were pooled and analyzed using descriptive and univariate analyses. Multivariable logistic regression was used to identify characteristics associated with hMPV versus RSV diagnosis, while multiple correspondence analysis (MCA) was performed to explore multivariate patterns of clinical presentation. Age-stratified sensitivity analyses were additionally performed. Overall, 102 cases were included, comprising 71 RSV (69.6%) and 31 hMPV (30.4%). hMPV cases were significantly older than RSV cases (41.5 years, interquartile range 3.5-63.0 vs. 1.5 years, interquartile range 0.2-31.0; p < 0.001) and had a higher burden of comorbidities. Myocarditis was the most frequently reported cardiac complication in both groups (87.1% hMPV vs. 74.6% RSV), followed by heart failure and pericarditis. ICU admission was more frequent among hMPV cases (96.8% vs. 77.5%; p = 0.034), whereas overall clinical outcomes did not significantly differ between groups. In exploratory multivariable analyses, dyspnea (aOR 16.280, 95% CI 1.370-193.475) and cough (aOR 6.059, 95% CI 1.062-34.552) were associated with hMPV diagnosis, whereas rhinorrhea (aOR 0.031, 95% CI 0.003-0.286) and lethargy/altered mental status (aOR 0.103, 95% CI 0.015-0.712) were associated with RSV diagnosis. ICU admission was also associated with hMPV diagnosis (aOR 11.033, 95% CI 1.125-108.173). These estimates were characterized by wide confidence intervals and should be interpreted cautiously. MCA showed substantial overlap between RSV and hMPV cases, without clear separation of their overall clinical presentation, while most between-group differences were attenuated in age-stratified analyses. In conclusion, both RSV and hMPV can be associated with a broad spectrum of potentially severe cardiac complications, with myocarditis representing the predominant reported manifestation. Despite some differences in demographic and clinical characteristics, their overall cardiac and clinical phenotypes substantially overlap. These findings support greater awareness of potential cardiac involvement during severe RSV and hMPV infections, while highlighting the need for prospective, systematically investigated cohorts to establish the incidence, mechanisms, and long-term outcomes of these complications.
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BibTeX
@article{ricco2026cardiac,
title = {{Cardiac Complications of Infections Due to Respiratory Syncytial Virus and Human Metapneumovirus: A Systematic Review and Pooled Analysis of Clinical Features.}},
author = {Matteo Riccò and Luca Pipitò and Claudio Costantino and Marco Bottazzoli and Paolo Manzoni and Marco Falcone and Pasquale Gianluca Giuri and Antonio Cascio},
journal = {Viruses},
year = {2026},
month = oct,
doi = {10.3390/v18101106},
url = {https://europepmc.org/article/MED/42944026},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cardiac Complications of Infections Due to Respiratory Syncytial Virus and Human Metapneumovirus: A Systematic Review and Pooled Analysis of Clinical Features.
AU - Matteo Riccò
AU - Luca Pipitò
AU - Claudio Costantino
AU - Marco Bottazzoli
AU - Paolo Manzoni
AU - Marco Falcone
AU - Pasquale Gianluca Giuri
AU - Antonio Cascio
PY - 2026
DA - 2026/10/07
JO - Viruses
DO - 10.3390/v18101106
UR - https://europepmc.org/article/MED/42944026
AB - Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are major causes of respiratory tract infections across different age groups. Although primarily regarded as respiratory pathogens, both viruses have been associated with cardiac complications, whose clinical spectrum remains incompletely characterized. We systematically reviewed published cases of RSV- and hMPV-associated cardiac involvement and compared their clinical characteristics and outcomes. PubMed, Scopus, and EMBASE were systematically searched for reports describing cardiac complications associated with laboratory-confirmed RSV or hMPV infection. Individual patient data were pooled and analyzed using descriptive and univariate analyses. Multivariable logistic regression was used to identify characteristics associated with hMPV versus RSV diagnosis, while multiple correspondence analysis (MCA) was performed to explore multivariate patterns of clinical presentation. Age-stratified sensitivity analyses were additionally performed. Overall, 102 cases were included, comprising 71 RSV (69.6%) and 31 hMPV (30.4%). hMPV cases were significantly older than RSV cases (41.5 years, interquartile range 3.5-63.0 vs. 1.5 years, interquartile range 0.2-31.0; p < 0.001) and had a higher burden of comorbidities. Myocarditis was the most frequently reported cardiac complication in both groups (87.1% hMPV vs. 74.6% RSV), followed by heart failure and pericarditis. ICU admission was more frequent among hMPV cases (96.8% vs. 77.5%; p = 0.034), whereas overall clinical outcomes did not significantly differ between groups. In exploratory multivariable analyses, dyspnea (aOR 16.280, 95% CI 1.370-193.475) and cough (aOR 6.059, 95% CI 1.062-34.552) were associated with hMPV diagnosis, whereas rhinorrhea (aOR 0.031, 95% CI 0.003-0.286) and lethargy/altered mental status (aOR 0.103, 95% CI 0.015-0.712) were associated with RSV diagnosis. ICU admission was also associated with hMPV diagnosis (aOR 11.033, 95% CI 1.125-108.173). These estimates were characterized by wide confidence intervals and should be interpreted cautiously. MCA showed substantial overlap between RSV and hMPV cases, without clear separation of their overall clinical presentation, while most between-group differences were attenuated in age-stratified analyses. In conclusion, both RSV and hMPV can be associated with a broad spectrum of potentially severe cardiac complications, with myocarditis representing the predominant reported manifestation. Despite some differences in demographic and clinical characteristics, their overall cardiac and clinical phenotypes substantially overlap. These findings support greater awareness of potential cardiac involvement during severe RSV and hMPV infections, while highlighting the need for prospective, systematically investigated cohorts to establish the incidence, mechanisms, and long-term outcomes of these complications.
SN - 1999-4915
ER -