Acute particulate matter exposure is associated with disturbances in heart rate complexity in patients with prior myocardial infarction

Chi-Sheng Hung; Ching-Chang Huang; Shih-Chun Pan; Hsi-Pin Ma; Ching-Chun Huang; Yue-Liang Leon Guo; Yi-Lwun Ho

doi:10.1016/j.scitotenv.2020.138842

Acute particulate matter exposure is associated with disturbances in heart rate complexity in patients with prior myocardial infarction

Sci Total Environ. 2020 Sep 1:733:138842. doi: 10.1016/j.scitotenv.2020.138842. Epub 2020 Apr 28.

Authors

Chi-Sheng Hung¹, Ching-Chang Huang¹, Shih-Chun Pan², Hsi-Pin Ma³, Ching-Chun Huang⁴, Yue-Liang Leon Guo⁵, Yi-Lwun Ho⁶

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
² Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
³ Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
⁴ Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and NTU Hospital, Taipei, Taiwan.
⁵ Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and NTU Hospital, Taipei, Taiwan. Electronic address: leonguo@ntu.edu.tw.
⁶ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: ylho@ntu.edu.tw.

PMID: 32446047
DOI: 10.1016/j.scitotenv.2020.138842

Abstract

Background: Ambient air pollutants can increase cardiovascular mortality. One possible mechanism is the effect on the autonomic balance of the cardiovascular system. Studies on acute effects of particulate matter (PM) exposure on heart rate variability (HRV), a surrogate marker for autonomic balance, in patients with prior myocardial infarction (MI) revealed inconsistent results.

Method: We prospectively enrolled participants with acute MI. These participants received a 24-hour Holter electrocardiography examination and echocardiography six months after the index MI. Linear [standard deviation of all normal to normal intervals, standard deviation of NN intervals (SDNN), and a low-frequency to high-frequency ratio (LF/HF)] and non-linear parameters of heart rate variability [multiscale entropy (MSE)] were calculated to show autonomic balance. Data for PM2.5, PM2.5-10, and PM10, were obtained from a fixed-site station in Taiwan. Linear mixed effect models were used to estimate acute effects (within 0-3 days) of PM exposure (per 10 μg/m3) on heart rate variability.

Results: A total of 90 participants were enrolled in this study with a mean age of 58.7 (13.3) and 83 (92.2%) male participants. Traditional HRV parameters, SDNN and LF/HF, were positively correlated with two-day lagged PM2.5-10 and PM10 [adjusted beta coefficient: SDNN: 130.3 and 58.5; LH/HF: 0.32 and 0.21 (all p < or = 0.01)]. MSE slopes 1-5 were negatively correlated with same-day PM2.5-10 and PM10 (adjusted beta coefficient -0.011 (p = 0.01) and -0.005 (p = 0.02), respectively). The left ventricular ejection fraction was negatively correlated with one-day lagged PM2.5-10, and PM10 (adjusted beta coefficient -0.49 and -0.4, respectively; both p < 0.05), after adjusting for MI size.

Conclusion: Our results suggest that coarse PM may acutely affect cardiac autonomic balance. MSE is a sensitive marker for detecting changes in autonomic imbalance in patients with prior MI following acute PM exposure.

Keywords: Air pollutants; Heart rate variability; Multiscale entropy; Particulate matter.

MeSH terms

Air Pollutants / analysis*
Heart Rate
Humans
Male
Myocardial Infarction*
Particulate Matter
Stroke Volume
Taiwan
Ventricular Function, Left

Substances

Air Pollutants
Particulate Matter