Both RSV and hMPV can be associated with a broad spectrum of potentially severe cardiac complications, with myocarditis the predominant reported manifestation, and their overall cardiac and clinical phenotypes substantially overlap despite some demographic and clinical differences.
The systematic review pooled 102 published cases of cardiac complications associated with laboratory-confirmed RSV or hMPV infection, 71 RSV and 31 hMPV.
hMPV cases were significantly older than RSV cases and had a higher burden of comorbidities.
Myocarditis was the most frequently reported cardiac complication in both groups, followed by heart failure and pericarditis.
ICU admission was more frequent among hMPV cases than RSV cases, while overall clinical outcomes did not differ significantly between groups.
In exploratory multivariable logistic regression, dyspnea and cough were associated with hMPV diagnosis, while rhinorrhea and lethargy/altered mental status were associated with RSV diagnosis.
ICU admission was independently associated with hMPV diagnosis in multivariable analysis.
Multiple correspondence analysis showed substantial overlap between RSV and hMPV cases without clear separation of their overall clinical presentation.
Most between-group differences were attenuated in age-stratified sensitivity analyses.
The authors conclude that prospective, systematically investigated cohorts are needed to establish incidence, mechanisms, and long-term outcomes of these cardiac complications.
RSV and human metapneumovirus (hMPV) are common respiratory viruses, but they can also affect the heart. This study pulled together 102 published cases of heart complications linked to confirmed RSV (71 cases) or hMPV (31 cases) infection to describe what these complications look like and how patients fared. Myocarditis (inflammation of the heart muscle) was the most commonly reported problem in both groups, followed by heart failure and pericarditis. Patients with hMPV were generally older and had more other health conditions than those with RSV, and they were more often admitted to intensive care. Some symptoms differed, such as more cough and shortness of breath with hMPV and more runny nose and lethargy with RSV, but these estimates were imprecise. When the researchers accounted for age, most differences shrank, and the overall picture of heart involvement looked very similar for the two viruses. This research suggests that heart involvement should be kept in mind during severe RSV or hMPV illness. However, because the data come from published case reports, which tend to describe unusual or severe cases, the study cannot say how often these complications occur. The authors call for prospective studies that systematically track heart problems in patients with these infections.
Riccò M, Pipitò L, Costantino C, Bottazzoli M, Manzoni P, Falcone M, et al.. (2026). Cardiac Complications of Infections Due to Respiratory Syncytial Virus and Human Metapneumovirus: A Systematic Review and Pooled Analysis of Clinical Features.. Viruses. https://doi.org/10.3390/v18101106