Short-Term Effects of Fine Particulate Matter and Ozone on the Cardiac Conduction System in Patients Undergoing Cardiac Catheterization

摘要

Background/Aim: Air pollution-induced changes in cardiac electrophysiological properties could be a pathway linking air pollution and cardiovascular events. Yet, evidence of air pollution effects on the cardiac conduction system is incomplete. We investigated short-term effects of particulate matter ≤ 2.5 μm in aerodynamic diameter (PM2.5) and ozone (O3) on cardiac electrical impulse propagation and repolarization as recorded in surface electrocardiograms (ECG). Methods: We analyzed repeated 12-lead ECG measurements performed on 5,819 patients between 2001 and 2012. The participants came from the Duke CATHGEN Study who underwent cardiac catheterization and resided in North Carolina, United States (NC, U.S.). Daily concentrations of PM2.5 and O3 at each participant's home address were predicted with hybrid air quality exposure models. We used generalized additive mixed models to investigate the associations of PM2.5 and O3 with the PR interval, QRS interval, heart-rate-corrected QT interval (QTc), and heart rate (HR). The temporal lag structures of the associations were examined using distributed-lag models. Results: We observed four-day lagged increases in the PR interval of 0.17% (95%CI: 0.02%-0.33%) and 0.34% (0.10%-0.57%), respectively, by interquartile increments of PM2.5 (7.0 ug/m3) and 03 (19.4 ppb); the associations remained significant up to 7-8 days after exposure. Elevated PM2.5 was also associated with increases in the QTc interval lagged by three and four days, and increases in HR lagged by one and two days. Significant effects were found on all investigated ECG parameters when analyses were restricted to exposure levels below the current U.S. National Ambient Air Quality Standards. Conclusions: In patients undergoing cardiac catheterization, short-term exposure to air pollution was associated with a delay in atrioventricular conduction and ventricular repolarization, as well as increased heart rate. This abstract does not necessarily reflect EPA policy.