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 journalArticlepeer-review

Abstract / Description of output

BACKGROUND: Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalizations, and mortality, but the biological basis of this remains unclear. We sought 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 (NO 2) and particulate matter with diameter of 2.5 µm or less (PM 2.5) 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 NO 2 was associated with higher indexed left ventricular (LV) mass (4.3 g/m 2 increase per interquartile range increase in NO 2, 95% confidence interval 1.9-7.0 g/m 2) and lower LV ejection fraction (-1.5% decrease per interquartile range increase in NO 2, 95% confidence interval -2.7% to -0.2%), independent of age, sex, socioeconomic 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 LV mass was greatest in women. These effects were specific to NO 2 exposure.

CONCLUSIONS: Exposure to air pollution is associated with raised LV mass and lower LV ejection fraction, with the strongest effect in women. Although epidemiological associations between air pollution and heart failure have been established and supported by preclinical studies, our findings provide novel empirical evidence of cardiac remodeling and exposure to air pollution with important clinical and public health implications.

Original languageEnglish
Pages (from-to)924-934
Number of pages11
JournalJournal of cardiac failure
Volume28
Issue number6
Early online date11 Jan 2022
DOIs
Publication statusPublished - 1 Jun 2022

Keywords / Materials (for Non-textual outputs)

  • Nitrogen dioxide
  • cardiomyopathy
  • heart
  • heart failure
  • particulate matter

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