Preventive cardiology
T-Wave Alternans, Air Pollution and Traffic in High-Risk Subjects

https://doi.org/10.1016/j.amjcard.2009.04.046Get rights and content

Particulate pollution has been linked to risk for cardiac death; possible mechanisms include pollution-related increases in cardiac electrical instability. T-wave alternans (TWA) is a marker of cardiac electrical instability measured as differences in the magnitude between adjacent T waves. In a repeated-measures study of 48 patients aged 43 to 75 years, associations of ambient and home indoor particulate pollution, including black carbon (BC) and reports of traffic exposure, with changes in 0.5-hourly maximum TWA (TWA-MAX), measured by 24-hour Holter electrocardiographic monitoring, were investigated. Each patient was observed up to 4 times within 1 year after percutaneous intervention for myocardial infarction, acute coronary syndromes without infarction, or stable coronary artery disease, for a total of 5,830 0.5-hour observations. Diary data for each 0.5-hour period defined whether a patient was home or not home, or in traffic. Increases in TWA-MAX were independently associated with the previous 2-hour mean ambient BC (2.1%, 95% confidence interval 0.9% to 3.3%) and with being in traffic in the previous 2 hours (6.1%, 95% confidence interval 3.4% to 8.8%). When subjects were home, indoor home BC effects were largest and most precise; when subjects were away from home, ambient central site BC effects were strongest. Increases in pollution increased the odds of TWA-MAX ≥75th percentile (odds ratio 1.4, 95% confidence interval 1.2 to 1.6 for a 1 μg/m3 increase in 6-hour mean BC). In conclusion, after hospitalization for coronary artery disease, being in traffic and short-term ambient or indoor BC exposure increased TWA, a marker of cardiac electrical instability.

Section snippets

Methods

The study design has been previously described.3 Briefly, before discharge, we recruited a panel of patients with documented coronary artery disease from the greater Boston area (within Interstate 495, a 40-km radius of our central monitoring site) who had undergone percutaneous coronary intervention for acute coronary syndromes (acute myocardial infarctions or unstable angina pectoris) or for worsening stable coronary artery disease. We excluded those with atrial fibrillation and left bundle

Results

Table 1 lists the median and range for TWA-MAX and 0.5-hour averaged heart rate for the 48 subjects, who had a total of 5,830 0.5-hour observations. The range of values for TWA-MAX ≥75th percentile was 26 to 61 μV. At the first home visit, 13 of 48 subjects described ≥1 episode of pain or discomfort in their chest since hospital discharge; 11 of the 13 with any chest pain described chest pain at rest. Over the subsequent visits 2 to 4, as activity levels increased, when asked “Since we last saw

Discussion

In the first 1 to 2 weeks after a myocardial infarction, the American College of Cardiology and American Heart Association guidelines recommend avoiding driving, particularly under stressful circumstances such as heavy traffic.9 These recommendations are based on studies suggesting that stress,9 including the stress of driving in traffic, may increase the risk for post–myocardial infarction complications. Our findings suggest that the particulate pollution from traffic sources itself, not only

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    This work was supported in part by Grant P01 ES009825, NIEHS-00002, from the National Institute of Environment Health Sciences, Research Triangle Park, North Carolina; Grant R832416-01-0 from the Environmental Protection Agency, Washington, District of Columbia.

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