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Short-term Effects of Fine Particulate Matter and Ozone on the Cardiac Conduction System in Patients Undergoing Cardiac Catheterization
Citation:
Zhang, S., S. Breitner, W. E. Cascio, R. B. Devlin, L. M. Neas, D. Diaz-Sanchez, W. Kraus, J. Schwartz, E. Hauser, A. Peters, AND A. Schneider. Short-term Effects of Fine Particulate Matter and Ozone on the Cardiac Conduction System in Patients Undergoing Cardiac Catheterization. Particle and Fibre Toxicology. BioMed Central Ltd, London, Uk, 15(1):38, (2018). https://doi.org/10.1186/s12989-018-0275-z
Impact/Purpose:
This paper makes a modest contribution by extending previous work on cardiac function after exposure to ambient air pollutants (PM2.5 and ozone) among 5804 patients receiving cardiac catheterizations at the Duke University Medical Center.
Description:
Background: Epidemiological studies have reported immediate effects of air pollution on cardiac ventricular repolarization. However, delayed air pollution effects on the cardiac conduction system beyond one day are unclear. Objective: We aimed to investigate the short-term effects of particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) and ozone (O3) on cardiac electrical conduction. Methods: We analyzed repeated electrocardiogram measurements of 5,804 patients from the Catheterization Genetics Study who underwent cardiac catheterization between 2001 and 2010 and resided in North Carolina (NC), USA. Daily concentrations of PM2.5 and O3 at each participant’s home address were predicted using a hybrid exposure model for NC. We examined immediate and delayed single-and multi-day effects of PM2.5 and O3 on heart rate (HR), PR interval, QRS interval, and HR-corrected QT interval (QTc) using generalized additive mixed models. The temporal lag structure was also examined using distributed-lag models. We evaluated effect modification by sociodemographic characteristics, smoking status, obesity, existing significant coronary artery disease (CAD), and history of myocardial infarction (MI). Results: PM2.5 and O3 were associated with delayed increases in HR, PR interval, and QTc interval (only PM2.5). For example, the PR interval increased by 0.16% (95%CI: 0.01%-0.31%) and 0.13% (95%CI: 0.05%-0.22%), respectively, corresponding to interquartile range increments in PM2.5 (7.0 μg/m3) and O3 (19.4 ppb) at lag4, and the effects remained significant up to one week after exposure. Participants who were of lower socioeconomic status, lived in rural areas, had significant CAD or a history of MI were more susceptible to the cardiac conduction effects of PM2.5 and O3. Conclusion: Short-term exposure to PM2.5 and O3 was associated with prolonged PR and QTc intervals, and increased heart rate mostly three to four days after exposure in patients with cardiovascular disease, suggesting delayed effects of air pollution on the prolongation in atrioventricular conduction and ventricular repolarization.
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DOI: Short-term Effects of Fine Particulate Matter and Ozone on the Cardiac Conduction System in Patients Undergoing Cardiac Catheterization