graph LR
Respiratory_Epithelial_Infection_and_Airway_Inflammation["Respiratory Epithelial Infection and Airway Inflammation"]
Nirsevimab["Nirsevimab"]
Nirsevimab --> Respiratory_Epithelial_Infection_and_Airway_Inflammation
style Respiratory_Epithelial_Infection_and_Airway_Inflammation fill:#dbeafe
style Nirsevimab fill:#fce7f3
graph LR
CircAdapt_virtual_pacing_CRT_response_twin["CircAdapt virtual-pacing CRT response twin"]
Tissue_Glucocorticoid_Amplification_by_11beta_HSD1["Tissue Glucocorticoid Amplification by 11beta-HSD1"]
SGLT2_Inhibitors["SGLT2 Inhibitors"]
Orthopnea["Orthopnea"]
Peripheral_Edema["Peripheral Edema"]
Postmenopausal_Oestrogen_Withdrawal["Postmenopausal Oestrogen Withdrawal"]
ARNI_Sacubitril_Valsartan["ARNI (Sacubitril/Valsartan)"]
CircAdapt_par_75_imaging_based_left_ventricular_digital_twin["CircAdapt par-75 imaging-based left-ventricular digital twin"]
Myocardial_Contractile_Dysfunction["Myocardial Contractile Dysfunction"]
BNP_NT_proBNP["BNP/NT-proBNP"]
Coronary_Artery_Disease["Coronary Artery Disease"]
Cardiac_Resynchronization_Therapy["Cardiac Resynchronization Therapy"]
Lipoproteina_Driven_Coronary_Microvascular_Dysfunction["Lipoprotein(a)-Driven Coronary Microvascular Dysfunction"]
Alcohol_Abuse["Alcohol Abuse"]
Hypertension["Hypertension"]
Neurohormonal_Activation["Neurohormonal Activation"]
Loss_of_Myocardial_Oestrogen_Receptor_Signalling["Loss of Myocardial Oestrogen Receptor Signalling"]
Troponin["Troponin"]
Mineralocorticoid_Receptor_Antagonists["Mineralocorticoid Receptor Antagonists"]
Dyspnea["Dyspnea"]
Fatigue["Fatigue"]
Cardiomegaly["Cardiomegaly"]
Fluid_Retention["Fluid Retention"]
Endocrine_Convergence_on_Shared_Profibrotic_Effectors["Endocrine Convergence on Shared Profibrotic Effectors"]
Exercise_Intolerance["Exercise Intolerance"]
Beta_Blockers["Beta Blockers"]
ACE_Inhibitors_ARBs["ACE Inhibitors/ARBs"]
Ventricular_Remodeling["Ventricular Remodeling"]
Diuretics["Diuretics"]
Myocardial_Contractile_Dysfunction --> Neurohormonal_Activation
Myocardial_Contractile_Dysfunction --> Exercise_Intolerance
Myocardial_Contractile_Dysfunction --> Fatigue
Neurohormonal_Activation --> Endocrine_Convergence_on_Shared_Profibrotic_Effectors
Neurohormonal_Activation --> Ventricular_Remodeling
Neurohormonal_Activation --> Fluid_Retention
Ventricular_Remodeling --> Myocardial_Contractile_Dysfunction
Fluid_Retention --> Dyspnea
Fluid_Retention --> Orthopnea
Fluid_Retention --> Peripheral_Edema
Endocrine_Convergence_on_Shared_Profibrotic_Effectors --> Ventricular_Remodeling
Tissue_Glucocorticoid_Amplification_by_11beta_HSD1 --> Endocrine_Convergence_on_Shared_Profibrotic_Effectors
Postmenopausal_Oestrogen_Withdrawal --> Loss_of_Myocardial_Oestrogen_Receptor_Signalling
Postmenopausal_Oestrogen_Withdrawal --> Endocrine_Convergence_on_Shared_Profibrotic_Effectors
Loss_of_Myocardial_Oestrogen_Receptor_Signalling --> Endocrine_Convergence_on_Shared_Profibrotic_Effectors
Lipoproteina_Driven_Coronary_Microvascular_Dysfunction --> Myocardial_Contractile_Dysfunction
Hypertension --> Ventricular_Remodeling
Coronary_Artery_Disease --> Myocardial_Contractile_Dysfunction
Alcohol_Abuse --> Myocardial_Contractile_Dysfunction
ACE_Inhibitors_ARBs --> Neurohormonal_Activation
Beta_Blockers --> Neurohormonal_Activation
Beta_Blockers --> Ventricular_Remodeling
ARNI_Sacubitril_Valsartan --> Neurohormonal_Activation
SGLT2_Inhibitors --> Fluid_Retention
Mineralocorticoid_Receptor_Antagonists --> Endocrine_Convergence_on_Shared_Profibrotic_Effectors
Diuretics --> Fluid_Retention
Cardiac_Resynchronization_Therapy --> Myocardial_Contractile_Dysfunction
CircAdapt_par_75_imaging_based_left_ventricular_digital_twin --> Myocardial_Contractile_Dysfunction
CircAdapt_virtual_pacing_CRT_response_twin --> Ventricular_Remodeling
Neurohormonal_Activation -.-> BNP_NT_proBNP
Myocardial_Contractile_Dysfunction -.-> Troponin
Ventricular_Remodeling -.-> Cardiomegaly
style CircAdapt_virtual_pacing_CRT_response_twin fill:#ecfccb
style Tissue_Glucocorticoid_Amplification_by_11beta_HSD1 fill:#dbeafe
style SGLT2_Inhibitors fill:#fce7f3
style Orthopnea fill:#fef3c7
style Peripheral_Edema fill:#fef3c7
style Postmenopausal_Oestrogen_Withdrawal fill:#dbeafe
style ARNI_Sacubitril_Valsartan fill:#fce7f3
style CircAdapt_par_75_imaging_based_left_ventricular_digital_twin fill:#ecfccb
style Myocardial_Contractile_Dysfunction fill:#dbeafe
style BNP_NT_proBNP fill:#e0e7ff
style Coronary_Artery_Disease fill:#dcfce7
style Cardiac_Resynchronization_Therapy fill:#fce7f3
style Lipoproteina_Driven_Coronary_Microvascular_Dysfunction fill:#dbeafe
style Alcohol_Abuse fill:#dcfce7
style Hypertension fill:#dcfce7
style Neurohormonal_Activation fill:#dbeafe
style Loss_of_Myocardial_Oestrogen_Receptor_Signalling fill:#dbeafe
style Troponin fill:#e0e7ff
style Mineralocorticoid_Receptor_Antagonists fill:#fce7f3
style Dyspnea fill:#fef3c7
style Fatigue fill:#fef3c7
style Cardiomegaly fill:#fef3c7
style Fluid_Retention fill:#dbeafe
style Endocrine_Convergence_on_Shared_Profibrotic_Effectors fill:#dbeafe
style Exercise_Intolerance fill:#fef3c7
style Beta_Blockers fill:#fce7f3
style ACE_Inhibitors_ARBs fill:#fce7f3
style Ventricular_Remodeling fill:#dbeafe
style Diuretics fill:#fce7f3
name: com_Respiratory_Syncytial_Virus_Infection__Heart_Failure
creation_date: "2026-06-25T12:00:00Z"
curation_status: CURATED
notes: >-
Directional trajectory: RSV hospitalization in older adults is associated with
subsequent cardiovascular events, including heart failure, in the year after
infection. The Intercept essay cited a ~1.3x heart-failure risk; the best
verifiable primary source (Verschoor 2025, JAGS) reports a substantially
LARGER and adjusted effect (HR range 1.48-3.74 across comparator groups), so
this entry is curated to the verified source rather than the blog figure.
Notably the same Ontario group (Kwong et al.) also reported RSV as a trigger
of acute MI (incidence ratio 3.51) in the influenza-MI study.
disease_a:
slug: Respiratory_Syncytial_Virus_Infection
disease_b:
slug: Heart_Failure
directionality: A_BEFORE_B
association_signals:
- source: LITERATURE
method: EHR_COHORT_ASSOCIATION
population: >-
Retrospective matched cohort of adults aged >=65 hospitalized with RSV vs
influenza, urinary tract infection, or fracture comparators, Ontario,
Canada, 2011-2020; cardiovascular outcomes to 1 year post-discharge.
directionality: A_BEFORE_B
statistics:
metrics:
- metric_type: HR
notes: >-
Adjusted hazard-ratio range 1.48-3.74 for subsequent heart failure in
RSV-hospitalized patients relative to each comparator group, in patients
with or without pre-existing cardiovascular conditions.
evidence:
- reference: PMID:40696870
reference_title: "Respiratory Syncytial Virus (RSV)-Related Hospitalization and Increased Rate of Cardiovascular Events in Older Adults."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "RSV hospitalization was associated with a greater rate of subsequent heart failure events relative to all other patient groups (HR range, 1.48-3.74), both in patients with or without pre-existing cardiovascular conditions."
explanation: >-
Matched cohort shows RSV hospitalization is associated with a higher
rate of subsequent heart failure across all comparator groups.
hypotheses:
- description: >-
Acute RSV infection imposes systemic inflammatory and cardiopulmonary stress
(hypoxemia, increased cardiac workload, a procoagulant/inflammatory milieu)
that can precipitate incident or worsening heart failure, particularly in
older adults, analogous to the post-influenza cardiovascular trigger.
evidence:
- reference: PMID:40696870
reference_title: "Respiratory Syncytial Virus (RSV)-Related Hospitalization and Increased Rate of Cardiovascular Events in Older Adults."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Our findings suggest that RSV is an important determinant of serious post-discharge cardiovascular outcomes in older adults."
explanation: >-
Supports RSV as a determinant of serious post-discharge cardiovascular
outcomes, including heart failure, in older adults.
pathophysiology:
- name: Infection-associated cardiopulmonary stress
description: >-
RSV-driven systemic inflammation and respiratory compromise increase
cardiac demand and can precipitate heart failure.
biological_processes:
- preferred_term: inflammatory response
term:
id: GO:0006954
label: inflammatory response
evidence:
- reference: PMID:40696870
reference_title: "Respiratory Syncytial Virus (RSV)-Related Hospitalization and Increased Rate of Cardiovascular Events in Older Adults."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Our findings suggest that RSV is an important determinant of serious post-discharge cardiovascular outcomes in older adults."
explanation: Supports a link from RSV infection to subsequent serious cardiovascular outcomes.