Ice hockey lung and NO2 poisoning

Nitrogen dioxide component of air pollution increases pulmonary congestion assessed by lung ultrasound in patients with chronic coronary syndromes

Pulmonary congestion is an intermediate biomarker and long-term predictor of acute decompensated heart failure.To evaluate the effects of air pollution on pulmonary congestion assessed by lung ultrasound.In a single-center, prospective, observational study design, we enrolled 1292 consecutive patients with chronic coronary syndromes referred for clinically indicated ABCDE-SE, with dipyridamole (n = 1207), dobutamine (n = 84), or treadmill exercise (n = 1). Pulmonary congestion was evaluated with lung ultrasound and a 4-site simplified scan. Same day values of 4 pollutants were obtained on the morning of testing (average of 6 h) from publicly available data sets of the regional authority of environmental protection. Assessment of air pollution included fine (< 2.5 µm diameter) and coarse (< 10 µm) particulate matter (PM), ozone and nitrogen dioxide (NO₂).NO₂ concentration was weakly correlated with rest (r = .089; p = 0.001) and peak stress B-lines (r = .099; p < 0.001). A multivariable logistic regression analysis, NO₂ values above the median (23.1 µg/m³) independently predicted stress B-lines with odds ratio = 1.480 (95% CI 1.118-1.958) together with age, hypertension, diabetes, and reduced (< 50%) ejection fraction. PM_2.5 values were higher in 249 patients with compared to those without B-lines (median and IQR, 22.0 [9.1-23.5] vs 17.6 [8.6-22.2] µg/m³, p < 0.001). No other pollutant correlated with other (A-C-D-E) SE steps.Higher concentration of NO₂ is associated with more pulmonary congestion mirrored by B-lines at lung ultrasound. Local inflammation mediated by NO₂ well within legally allowed limits may increase the permeability of the alveolar-capillary barrier and therefore pulmonary congestion in susceptible subjects.ClinicalTrials.gov Identifier: NCT030.49995.