Air Pollution, Heart Failure and Atrial Fibrillation in MESA

摘要 考夫曼：梅萨的空气污染、心力衰竭和房颤负担 该提案审查了环境空气污染物对发展的影响，负担，并触发 心力衰竭和心房纤颤。空气污染物，特别是颗粒物，与 心血管疾病，特别是冠心病和中风的发病率。冠心病的发病率 由于预防工作，心脏病和中风正在减少，而心力衰竭（HF， 尤其是射血分数保留的患者，HFpEF）和房性心律失常（尤其是心房颤动，AF）， 成为心血管疾病负担的重要组成部分;环境因素的作用 这两种经常共存的疾病的因素在很大程度上没有研究。多种族研究 动脉粥样硬化（梅萨）是一个非常有价值的队列，了解预测和相关的 心力衰竭和房颤，由于参与者的年龄，广泛的现有表型， 在2016年开始的考试中进行评估。此外，梅萨已成为最仔细研究的 在暴露于环境空气污染物方面，这项拟议中的研究将扩大空气污染物 使用创新的低成本室内和室外家庭监控和最先进的技术进行表征 建模方法包含广泛的地理输入。我们将描述 长期暴露于细颗粒物（PM2.5）、氮氧化物（NOX）、 二氧化碳（NO2）、臭氧（O3）和一氧化碳（CO），以及早期心力衰竭和心房颤动的发生 心律失常，以及短期暴露于空气污染物和触发心房颤动之间的关系 心律失常和AF负担。了解这些关系很重要，因为：1）空气污染物是 与心血管死亡率相关; 2）HF和HF的结构性疾病相关性是AF的危险因素; （3）HFpEF合并AF是一组死亡率特别高的人群。我们将估计长期（年度） PM2.5、NOX、NO2、O3和CO在室外和室内的短期（小时和日）浓度 所有梅萨参与者的家中使用最先进的监测技术和时空统计 模型我们将在梅萨参与家庭的一部分使用新型低成本污染物监测传感器， 社区位置。流行的HF亚型和新出现的亚表型的早期证据将是 使用来自检查中超声心动图心脏参数、6分钟步行试验结果 动脉张力测定和生物标志物（NTproBNP、sST 2、半乳糖凝集素-3）。新型两周动态心电图监测 对植入的起搏器和心律转复器的询问将使我们能够评估 长期空气污染暴露与AF和短期空气污染之间的关联以及 房性心律失常通过这项工作，我们将对空气污染物在 心血管疾病的发展，重点关注HF，尤其是HFpEF和AF。

Abstract Kaufman: Air pollution, heart failure, and atrial fibrillation burden in MESA This proposal examines the impact of ambient air pollutants on the development, burden, and triggering of heart failure and atrial fibrillation. Air pollutants, especially particulate matter, have been associated with the incidence of cardiovascular disease, especially coronary heart disease and stroke. The incidence of coronary heart disease and stroke is declining due to prevention efforts, while development of heart failure (HF, especially with preserved ejection fraction, HFpEF) and atrial arrhythmias (especially atrial fibrillation, AF) are becoming more important components of the burden of cardiovascular disease; the role of environmental factors in these two frequently co-existing conditions diseases is largely unstudied. The Multi-Ethnic Study of Atherosclerosis (MESA) is an extraordinarily valuable cohort for understanding predictors and correlates of heart failure and atrial fibrillation, due to participants’ ages, extensive existing phenotyping, and planned assessment in an examination beginning in 2016. In addition, MESA has become the most carefully studied cohort in terms of exposure to ambient air pollutants. This proposed study will extend the air pollutant characterization using innovative low-cost indoor and outdoor home-based monitoring and state-of-the-art modeling approaches incorporating extensive geographic inputs. We will characterize both the relationship between long-term ambient exposures to fine particulate matter (PM2.5), oxides of nitrogen (NOX), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO), and development of early stage heart failure and atrial arrhythmias, and the relationship between short-term exposure to air pollutants and triggering of atrial arrhythmias and AF burden. It is important to understand these relationships since: 1) Air pollutants are associated with cardiovascular mortality; 2) HF and structural disease correlates of HF are risk factors for AF; and 3) HFpEF with AF represents a group at especially high mortality risk. We will estimate long-term (annual average) and short-term (hourly and daily) concentrations of PM2.5, NOX, NO2, O3, and CO, outside and inside all MESA participants’ homes using state-of-the-art monitoring technology and spatiotemporal statistical models. We will use novel low-cost pollutant monitoring sensors at a subset of MESA participant homes and community locations. Early evidence of prevalent HF subtypes and newly emerging sub-phenotypes will be assessed using information from in-exam echocardiographic cardiac parameters, 6-minute walk test results, arterial tonometry, and biomarkers (NTproBNP, sST2, galectin-3). Ambulatory novel two-week ECG monitoring and interrogations of implanted pacemakers and cardioverter-defibrillators will allow us to assess the association between long-term air pollution exposure and AF and short-term air pollution and the triggering of atrial arrhythmias. Through this effort, we will gain unprecedented insight into the role of air pollutants in development of cardiovascular disease, with a focus on HF, especially HFpEF, and on AF.