Altered cardiac repolarization in association with air pollution and air temperature among myocardial infarction survivors.
BACKGROUND
Epidemiological studies have shown that ambient particulate matter (PM) and changes in air temperature are associated with increased cardiopulmonary events.


OBJECTIVE
We hypothesized that patients with previous myocardial infarction (MI) experience changes in heart rate (HR) and repolarization parameters, such as Bazett-corrected QT interval (QTc), and T-wave amplitude (Tamp), in association with increases in air pollution and temperature changes.


METHODS
Between May 2003 and February 2004, 67 MI survivors from the Augsburg KORA-MI registry repeatedly sent 16 sec electrocardiograms (ECGs) with a personal transmitter (Viapac) via telephone to the Philips Monitoring Center, where ECG parameters were immediately analyzed. Meteorological data and air pollutants were acquired from fixed monitoring sites on an hourly basis. Additive mixed models were used for analysis. Effect modification by patient characteristics was investigated.


RESULTS
The analysis of the 1,745 ECGs revealed an increased HR associated with interquartile range (IQR) increases in PM levels among participants not using beta-adrenergic receptor blockers and among those with body mass index ≥ 30 kg/m². We observed a 24- to 47-hr lagged QTc prolongation [0.5% change (95% confidence interval, 0.0-1.0%)] in association with IQR increases in levels of PM ≤ 2.5 µm in aerodynamic diameter, especially in patients with one [0.6% (0.1-1.0%)] or two [1.2% (0.4-2.1%)] minor alleles of the nuclear factor (erythroid-derived 2)-like 2 (NFE2L2) single-nucleotide polymorphism rs2364725. Positive immediate (0-23 hr) and inverse delayed (48-71 hr up to 96-119 hr) associations were evident between PM and Tamp. We detected an inverse U-shaped association between temperature and Tamp, with a maximum Tamp at 5°C.


CONCLUSIONS
Increased air pollution levels and temperature changes may lead to changes in HR and repolarization parameters that may be precursors of cardiac problems.
Hampel
Regina
R
Helmholtz Zentrum München-German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany. regina.hampel@helmholtz-muenchen.de
Schneider
Alexandra
A
Brüske
Irene
I
Zareba
Wojciech
W
Cyrys
Josef
J
Rückerl
Regina
R
Breitner
Susanne
S
Korb
Harald
H
Sunyer
Jordi
J
Wichmann
H-Erich
HE
Peters
Annette
A
D000393:Air Pollutants / Q000032:analysis* / Q000633:toxicity; D000397:Air Pollution / Q000706:statistics & numerical data*; D001272:Atmosphere / Q000737:chemistry; D002980:Climate; D004562:Electrocardiography; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology*; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity; D017741:Survivors / Q000706:statistics & numerical data*; D013696:Temperature
D000393:Air Pollutants; D052638:Particulate Matter