EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY

Daniela Fecht; Marc Chadeau-Hyam; Ruth  Owen; John  Gregson; Brian P Halliday; Amrit S Lota; John  Gulliver; James S  Ware; Dudley J Pennell; Frank J Kelly; Anoop S V Shah; Mark R Miller; David E Newby; Sanjay K Prasad; Upasana Tayal

doi:10.1016/j.cardfail.2021.11.023

EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY

Daniela Fecht, Marc Chadeau-Hyam, Ruth Owen, John Gregson, Brian P Halliday, Amrit S Lota, John Gulliver, James S Ware, Dudley J Pennell, Frank J Kelly, Anoop S V Shah, Mark R Miller, David E Newby, Sanjay K Prasad, Upasana Tayal^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Rationale: Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalisations and mortality, but the biological basis of this remains unclear.

Objective: To determine the relationship between differential air pollution levels and changes in cardiac structure and function in patients with dilated cardiomyopathy.

Methods and Results: We undertook a prospective longitudinal observational cohort study of patients in England with dilated cardiomyopathy (enrollment 2009-2015; n=716, 66% male, 85% Caucasian) and conducted cross sectional analysis at the time of study enrollment. Annual average air pollution exposure estimates for nitrogen dioxide (NO2) and particulate matter with diameter ≤ 2.5µm (PM2.5) at enrolment were assigned to each residential postcode (on average 12 households). The relationship between air pollution and cardiac morphology was assessed using linear regression modelling. Greater ambient exposure to NO2 was associated with higher indexed left ventricular mass (4.3 g/m2 increase per interquartile range (IQR) increase in NO2, 95% CI 1.9 to 7.0 g/m2) and lower left ventricular ejection fraction (-1.5% decrease per IQR increase in NO2, 95% CI -2.7 to -0.2%), independent of age, sex, socio-economic status and clinical covariates. The associations were robust to adjustment for smoking status and geographical clustering by postcode area. The effect of air pollution on left ventricular mass was greatest in women. These effects were specific to NO2 exposure.

Conclusion: Exposure to air pollution is associated with raised left ventricular mass and lower left ventricular ejection fraction, with the strongest effect in women. Whilst epidemiological associations between air pollution and heart failure have been established and supported by pre-clinical studies, our findings provide novel empirical evidence of cardiac remodelling and exposure to air pollution with important clinical and public health implications.

Original language	English
Journal	Journal of cardiac failure
Early online date	11 Jan 2022
DOIs	https://doi.org/10.1016/j.cardfail.2021.11.023
Publication status	E-pub ahead of print - 11 Jan 2022

Keywords

Cardiomyopathy
Environment
risk factors
Women
sex and gender
magnetic resonance imaging

Access to Document

10.1016/j.cardfail.2021.11.023

Embargoed Document

Main text_accepted_24.11.21
Accepted author manuscript, 16.5 MB
Licence: Creative Commons: Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND)
Embargo ends: 11/01/23

1 Finished

Atherothrombotic effects of air pollution (renewal)
Newby, D.
UK-based charities
1/07/10 → 30/06/15
Project: Research

Cite this

Fecht, D., Chadeau-Hyam, M., Owen, R., Gregson, J., Halliday, B. P., Lota, A. S., Gulliver, J., Ware, J. S., Pennell, D. J., Kelly, F. J., Shah, A. S. V., Miller, M. R., Newby, D. E., Prasad, S. K., & Tayal, U. (2022). EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY. Journal of cardiac failure. https://doi.org/10.1016/j.cardfail.2021.11.023

Fecht, Daniela ; Chadeau-Hyam, Marc ; Owen, Ruth ; Gregson, John ; Halliday, Brian P ; Lota, Amrit S ; Gulliver, John ; Ware, James S ; Pennell, Dudley J ; Kelly, Frank J ; Shah, Anoop S V ; Miller, Mark R ; Newby, David E ; Prasad, Sanjay K ; Tayal, Upasana. / EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY. In: Journal of cardiac failure. 2022.

@article{83a903cc49e047dd9a19c70c99c0371f,

title = "EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY",

abstract = "Rationale: Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalisations and mortality, but the biological basis of this remains unclear. Objective: To determine the relationship between differential air pollution levels and changes in cardiac structure and function in patients with dilated cardiomyopathy. Methods and Results: We undertook a prospective longitudinal observational cohort study of patients in England with dilated cardiomyopathy (enrollment 2009-2015; n=716, 66% male, 85% Caucasian) and conducted cross sectional analysis at the time of study enrollment. Annual average air pollution exposure estimates for nitrogen dioxide (NO2) and particulate matter with diameter ≤ 2.5µm (PM2.5) at enrolment were assigned to each residential postcode (on average 12 households). The relationship between air pollution and cardiac morphology was assessed using linear regression modelling. Greater ambient exposure to NO2 was associated with higher indexed left ventricular mass (4.3 g/m2 increase per interquartile range (IQR) increase in NO2, 95% CI 1.9 to 7.0 g/m2) and lower left ventricular ejection fraction (-1.5% decrease per IQR increase in NO2, 95% CI -2.7 to -0.2%), independent of age, sex, socio-economic status and clinical covariates. The associations were robust to adjustment for smoking status and geographical clustering by postcode area. The effect of air pollution on left ventricular mass was greatest in women. These effects were specific to NO2 exposure. Conclusion: Exposure to air pollution is associated with raised left ventricular mass and lower left ventricular ejection fraction, with the strongest effect in women. Whilst epidemiological associations between air pollution and heart failure have been established and supported by pre-clinical studies, our findings provide novel empirical evidence of cardiac remodelling and exposure to air pollution with important clinical and public health implications.",

keywords = "Cardiomyopathy, Environment, risk factors, Women, sex and gender, magnetic resonance imaging",

author = "Daniela Fecht and Marc Chadeau-Hyam and Ruth Owen and John Gregson and Halliday, {Brian P} and Lota, {Amrit S} and John Gulliver and Ware, {James S} and Pennell, {Dudley J} and Kelly, {Frank J} and Shah, {Anoop S V} and Miller, {Mark R} and Newby, {David E} and Prasad, {Sanjay K} and Upasana Tayal",

year = "2022",

month = jan,

day = "11",

doi = "10.1016/j.cardfail.2021.11.023",

language = "English",

journal = "Journal of cardiac failure",

issn = "1532-8414",

publisher = "Churchill Livingstone",

}

Fecht, D, Chadeau-Hyam, M, Owen, R, Gregson, J, Halliday, BP, Lota, AS, Gulliver, J, Ware, JS, Pennell, DJ, Kelly, FJ, Shah, ASV, Miller, MR , Newby, DE, Prasad, SK & Tayal, U 2022, 'EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY', Journal of cardiac failure. https://doi.org/10.1016/j.cardfail.2021.11.023

EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY. / Fecht, Daniela; Chadeau-Hyam, Marc; Owen, Ruth ; Gregson, John ; Halliday, Brian P; Lota, Amrit S; Gulliver, John ; Ware, James S ; Pennell, Dudley J; Kelly, Frank J; Shah, Anoop S V; Miller, Mark R ; Newby, David E; Prasad, Sanjay K; Tayal, Upasana.

In: Journal of cardiac failure, 11.01.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY

AU - Fecht, Daniela

AU - Chadeau-Hyam, Marc

AU - Owen, Ruth

AU - Gregson, John

AU - Halliday, Brian P

AU - Lota, Amrit S

AU - Gulliver, John

AU - Ware, James S

AU - Pennell, Dudley J

AU - Kelly, Frank J

AU - Shah, Anoop S V

AU - Miller, Mark R

AU - Newby, David E

AU - Prasad, Sanjay K

AU - Tayal, Upasana

PY - 2022/1/11

Y1 - 2022/1/11

N2 - Rationale: Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalisations and mortality, but the biological basis of this remains unclear. Objective: To determine the relationship between differential air pollution levels and changes in cardiac structure and function in patients with dilated cardiomyopathy. Methods and Results: We undertook a prospective longitudinal observational cohort study of patients in England with dilated cardiomyopathy (enrollment 2009-2015; n=716, 66% male, 85% Caucasian) and conducted cross sectional analysis at the time of study enrollment. Annual average air pollution exposure estimates for nitrogen dioxide (NO2) and particulate matter with diameter ≤ 2.5µm (PM2.5) at enrolment were assigned to each residential postcode (on average 12 households). The relationship between air pollution and cardiac morphology was assessed using linear regression modelling. Greater ambient exposure to NO2 was associated with higher indexed left ventricular mass (4.3 g/m2 increase per interquartile range (IQR) increase in NO2, 95% CI 1.9 to 7.0 g/m2) and lower left ventricular ejection fraction (-1.5% decrease per IQR increase in NO2, 95% CI -2.7 to -0.2%), independent of age, sex, socio-economic status and clinical covariates. The associations were robust to adjustment for smoking status and geographical clustering by postcode area. The effect of air pollution on left ventricular mass was greatest in women. These effects were specific to NO2 exposure. Conclusion: Exposure to air pollution is associated with raised left ventricular mass and lower left ventricular ejection fraction, with the strongest effect in women. Whilst epidemiological associations between air pollution and heart failure have been established and supported by pre-clinical studies, our findings provide novel empirical evidence of cardiac remodelling and exposure to air pollution with important clinical and public health implications.

AB - Rationale: Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalisations and mortality, but the biological basis of this remains unclear. Objective: To determine the relationship between differential air pollution levels and changes in cardiac structure and function in patients with dilated cardiomyopathy. Methods and Results: We undertook a prospective longitudinal observational cohort study of patients in England with dilated cardiomyopathy (enrollment 2009-2015; n=716, 66% male, 85% Caucasian) and conducted cross sectional analysis at the time of study enrollment. Annual average air pollution exposure estimates for nitrogen dioxide (NO2) and particulate matter with diameter ≤ 2.5µm (PM2.5) at enrolment were assigned to each residential postcode (on average 12 households). The relationship between air pollution and cardiac morphology was assessed using linear regression modelling. Greater ambient exposure to NO2 was associated with higher indexed left ventricular mass (4.3 g/m2 increase per interquartile range (IQR) increase in NO2, 95% CI 1.9 to 7.0 g/m2) and lower left ventricular ejection fraction (-1.5% decrease per IQR increase in NO2, 95% CI -2.7 to -0.2%), independent of age, sex, socio-economic status and clinical covariates. The associations were robust to adjustment for smoking status and geographical clustering by postcode area. The effect of air pollution on left ventricular mass was greatest in women. These effects were specific to NO2 exposure. Conclusion: Exposure to air pollution is associated with raised left ventricular mass and lower left ventricular ejection fraction, with the strongest effect in women. Whilst epidemiological associations between air pollution and heart failure have been established and supported by pre-clinical studies, our findings provide novel empirical evidence of cardiac remodelling and exposure to air pollution with important clinical and public health implications.

KW - Cardiomyopathy

KW - Environment

KW - risk factors

KW - Women

KW - sex and gender

KW - magnetic resonance imaging

U2 - 10.1016/j.cardfail.2021.11.023

DO - 10.1016/j.cardfail.2021.11.023

M3 - Article

JO - Journal of cardiac failure

JF - Journal of cardiac failure

SN - 1532-8414

ER -

EXPOSURE TO ELEVATED NITROGEN DIOXIDE CONCENTRATIONS AND CARDIAC REMODELLING IN PATIENTS WITH DILATED CARDIOMYOPATHY

Abstract

Keywords

Access to Document

Embargoed Document

Fingerprint

Projects

Atherothrombotic effects of air pollution (renewal)

Cite this