Cardiovascular involvement in Epstein-Barr virus infection

Abstract

Cardiovascular involvement is an uncommon but severe complication of Epstein-Barr virus (EBV) infection caused by direct damage and immune injury. Recently, it has drawn increasing attention due to its dismal prognosis. It can manifest in various ways, including coronary artery dilation (CAD), coronary artery aneurysm (CAA), myocarditis, arrhythmias, and heart failure, among others. If not treated promptly, cardiovascular damage can progress over time and even lead to death, which poses a challenge to clinicians. Early diagnosis and treatment can improve the prognosis and reduce mortality. However, there is a lack of reliable large-scale data and evidence-based guidance for the management of cardiovascular damage. Consequently, in this review, we attempt to synthesize the present knowledge of cardiovascular damage associated with EBV and to provide an overview of the pathogenesis, classification, treatment, and prognosis, which may enhance the recognition of cardiovascular complications related to EBV and may be valuable to their clinical management.

Keywords: Epstein–Barr virus (EBV); cardiovascular damage; coronary artery lesions (CALs); immune injury; myocarditis.

Figure 1

Pathogenesis of cardiovascular damage. The mechanism of cardiovascular damage caused by Epstein–Barr virus (EBV) infection is mainly divided into direct and indirect damage. Direct damage refers to the positive detection rate of the EBV virus gene in endomyocardial samples. Indirect damage, also called immune damage, consists of innate and adaptive immune activations that cause cardiac involvements, such as coronary artery lesions, myocarditis, pericardial diseases, valvular heart disease, and heart failure. This figure was drawn on the Figdraw website (https://www.figdraw.com/static/index.html).

Figure 2

Differences in cardiovascular manifestations in Epstein–Barr virus (EBV) infection between children and adults. The spectrum of cardiovascular manifestations associated with EBV differs between children and adults: coronary artery lesions, valvulopathy, and pericardial effusion are more common in children, while myocarditis and heart failure usually occur in adults. This figure was drawn with the Canva software and the health icons accessed at https://healthicons.org/.