title: Air pollution and heart failure: Relationship with the ejection fraction.
abstract: OBJECTIVE
  To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction.
  
  
  METHODS
  We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission.
  
  
  RESULTS
  The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m(3) vs 4.50 ± 2.34 μg/m(3), P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03).
  
  
  CONCLUSIONS
  This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.
authors.affiliation: Alberto Dominguez-Rodriguez, Ruben A Juarez-Prera, Eduardo Arroyo-Ucar, Department of Cardiology, Hospital Universitario de Canarias, E-38320 Santa Cruz de Tenerife, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dominguez-Rodriguez
authors.forename: Javier
authors.initials: J
authors.lastname: Abreu-Afonso
authors.forename: Sergio
authors.initials: S
authors.lastname: Rodríguez
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Juarez-Prera
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arroyo-Ucar
authors.forename: Yenny
authors.initials: Y
authors.lastname: Gonzalez
authors.forename: Pedro
authors.initials: P
authors.lastname: Abreu-Gonzalez
authors.forename: Pablo
authors.initials: P
authors.lastname: Avanzas
keywords: Air pollution; Heart failure; Nitrogen dioxide; Preserved ejection fraction; Reduced ejection fraction
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