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Ruedisueli I, Shi K, Lopez S, Gornbein J, Middlekauff HR. Arrhythmogenic effects of acute electronic cigarette compared to tobacco cigarette smoking in people living with HIV. Physiol Rep 2024; 12:e16158. [PMID: 39044007 PMCID: PMC11265994 DOI: 10.14814/phy2.16158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
The leading cause of death in people living with HIV (PLWH) is cardiovascular disease, and the high prevalence of tobacco cigarette (TC) smoking is a major contributor. Switching to electronic cigarettes (ECs) has been promoted as a harm reduction strategy. We sought to determine if acute EC compared to TC smoking had less harmful effects on arrhythmogenic risk factors including acute changes in hemodynamics, heart rate variability (HRV), and ventricular repolarization (VR). In PLWH who smoke, changes in hemodynamics, HRV, and VR were compared pre/post acutely using an EC, TC, or puffing on an empty straw on different days in random order, in a crossover study. Thirty-seven PLWH (36 males, mean age 40.5 ± 9.1 years) participated. Plasma nicotine was greater after TC versus EC use (10.12 ± 0.96 vs. 6.18 ± 0.99 ng/mL, respectively, p = 0.004). HR increased significantly, and similarly, after acute EC and TC smoking compared to control. Changes in HRV that confer increased cardiac risk (LF/HF ratio) were significantly smaller after acute EC versus TC use, consistent with a harm reduction effect. In a post-hoc analysis of PLWH with and without positive concurrent recreational drug use as indicated by point of care urine toxicology testing, this differential effect was only seen in PLWH not currently using recreational drugs. Changes in VR were not different among the three exposures. In PLWH who smoke, EC compared to TC smoking resulted in smaller adverse changes in HRV. This differential effect was accompanied by a smaller increase in plasma nicotine, and was negated by concurrent recreational drug use. Additional studies are warranted in this vulnerable population disproportionately affected by tobacco-related health disparities.
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Affiliation(s)
- Isabelle Ruedisueli
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Katie Shi
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Samuel Lopez
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Jeffrey Gornbein
- Departments of Medicine and Computational MedicineUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Holly R. Middlekauff
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
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Irfan A, Riggs DW, Koromia G, DeFilippis AP, Soliman EZ, Bhatnagar A, Carll AP. Smoking-associated Electrocardiographic Abnormalities Predict Cardiovascular Mortality: Insights from NHANES. RESEARCH SQUARE 2024:rs.3.rs-3615687. [PMID: 38260619 PMCID: PMC10802705 DOI: 10.21203/rs.3.rs-3615687/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background— Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. Abnormal electrocardiogram (ECG) durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization (PR interval and segment), predict cardiac arrhythmia and mortality. Objectives— To elucidate how smoking affects cardiac excitation, we assessed in a nationally representative sample (NHANES III) associations between cotinine, abnormalities in P duration, PR interval, PR segment, rate-corrected QT (QTc), QRS duration, and JT interval, and long-term mortality. Methods— We analyzed data from 5,633 adults using survey-weighted multinomial logistic regression to estimate associations between tobacco use (>15 ng/ml serum cotinine) and short (<5th percentile) or long (>95th percentile) ECG intervals, relative to reference (5 - 95th percentile). Results— After adjustment for demographics, risk factors, and conduction-altering medications, smoking was associated with a higher odds of short PR interval, PR segment, and QRS, and long JT. Broader ECG effects of smoking were also assessed by survey-weighted linear regression of continuous cotinine and ECG intervals, which revealed cotinine inversely associated with PR segment and QTc. Over a 22-year follow-up, many ECG abnormalities predicted cardiovascular mortality in smokers, including long JT, QRS, and QTc, and short QRS. Conclusions— Smoking increases likelihood for rapid atrioventricular conduction, rapid ventricular depolarization, and slow ventricular repolarization. The ventricular electrophysiologic abnormalities associated with smoking also predict cardiovascular mortality in smokers; however, traditional ECG measures of cardiac risk like QTc can overlook these ventricular defects and their independent predictive value in smokers.
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Ruedisueli I, Lakhani K, Nguyen R, Gornbein J, Middlekauff HR. Electronic cigarettes prolong ventricular repolarization in people who smoke tobacco cigarettes: implications for harm reduction. Am J Physiol Heart Circ Physiol 2023; 324:H821-H832. [PMID: 37057991 PMCID: PMC10191123 DOI: 10.1152/ajpheart.00057.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Abstract
Electronic cigarettes are often used for smoking cessation as a harm reduction strategy, but studies comparing risks of electronic cigarettes (ECs) and tobacco cigarettes (TCs) are scarce. Ventricular repolarization in people who smoke TCs is abnormal. Baseline repolarization was compared among nonusers (people who do not use TCs or ECs) and people who use ECs or TCs. The acute effects of ECs and TCs on metrics of ventricular repolarization were then compared in people who chronically smoke. A total of 110 participants (59 female), including 35 people (21 females) in the TC cohort, 34 people (17 females) in the EC cohort, and 41 people (21 females) in the nonuser cohort, were included. None of the primary outcomes, Tpeak-end (Tp-e), Tp-e/QT, and Tp-e/QTc, were different among the three cohorts at supine baseline, even when adjusted for sex. When compared with the control exposure standing after acutely using the EC but not the TC, significantly prolonged all three primary indices of ventricular repolarization in people who smoke TCs. The major new finding in this study is that in people who smoke TCs, using an EC compared with a TC significantly prolongs ventricular repolarization. Furthermore, in our subgroup analysis by sex, this adverse effect on repolarization is found only in male, not female, smokers. In summary, chronic TC smoking is the most prevalent, modifiable risk factor for cardiovascular death, including sudden cardiac death. If used for smoking cessation, ECs should only be used in the short term since they too carry their own risks; this risk appears to be greatest in males compared with females who smoke.NEW & NOTEWORTHY The major new finding in this study is that in people who smoke tobacco cigarettes, using an electronic cigarette but not a tobacco cigarette acutely and significantly prolongs several metrics of ventricular repolarization, including Tpeak-Tend, Tpeak-Tend/QT, and Tpeak-Tend/QTc. Furthermore, in our subgroup analysis by sex, this adverse effect on repolarization is found only in male, not female, smokers.
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Affiliation(s)
- Isabelle Ruedisueli
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Karishma Lakhani
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Randy Nguyen
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Jeffrey Gornbein
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, United States
- Department of Computational Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Holly R Middlekauff
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, United States
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E-cigarettes and their lone constituents induce cardiac arrhythmia and conduction defects in mice. Nat Commun 2022; 13:6088. [PMID: 36284091 PMCID: PMC9596490 DOI: 10.1038/s41467-022-33203-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/24/2022] [Indexed: 01/11/2023] Open
Abstract
E-cigarette use has surged, but the long-term health effects remain unknown. E-cigarette aerosols containing nicotine and acrolein, a combustion and e-cigarette byproduct, may impair cardiac electrophysiology through autonomic imbalance. Here we show in mouse electrocardiograms that acute inhalation of e-cigarette aerosols disturbs cardiac conduction, in part through parasympathetic modulation. We demonstrate that, similar to acrolein or combustible cigarette smoke, aerosols from e-cigarette solvents (vegetable glycerin and propylene glycol) induce bradycardia, bradyarrhythmias, and elevations in heart rate variability during inhalation exposure, with inverse post-exposure effects. These effects are slighter with tobacco- or menthol-flavored aerosols containing nicotine, and in female mice. Yet, menthol-flavored and PG aerosols also increase ventricular arrhythmias and augment early ventricular repolarization (J amplitude), while menthol uniquely alters atrial and atrioventricular conduction. Exposure to e-cigarette aerosols from vegetable glycerin and its byproduct, acrolein, diminish heart rate and early repolarization. The pro-arrhythmic effects of solvent aerosols on ventricular repolarization and heart rate variability depend partly on parasympathetic modulation, whereas ventricular arrhythmias positively associate with early repolarization dependent on the presence of nicotine. Our study indicates that chemical constituents of e-cigarettes could contribute to cardiac risk by provoking pro-arrhythmic changes and stimulating autonomic reflexes.
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Yetkin E. Meet the Section Editor. Curr Cardiol Rev 2022. [DOI: 10.2174/1573403x1802220318102505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Keskin G, Karaman ST, Basat O. Evaluation of the relationship between the level of addiction and exhaled carbon monoxide levels with QT dispersion in smokers. Tob Induc Dis 2021; 19:22. [PMID: 33815033 PMCID: PMC8010797 DOI: 10.18332/tid/133053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoking increases the risk of arrhythmia. QT dispersion (QTd) is an important indicator for the determination of ventricular arrhythmia. In this study, we aimed to determine the arrhythmia risk by evaluating QTd in smokers and to assess the relationship between the level of nicotine addiction and carbon monoxide (CO) level in the expiratory air. METHODS This study was designed as a single-center, cross-sectional study. Among the chronic smokers referred to the Smoking Cessation Clinic of a tertiary hospital between October 2019 and January 2020, all those who had no risk factors for cardiac arrhythmias, except smoking, were included in the study. Sociodemographic data and smoking characteristics of the participants were collected and exhaled CO levels were measured. QT intervals were measured in all leads by using a 12-lead standard electrocardiogram (ECG), and heart rate corrected QT (QTc) intervals, QT dispersion (QTd), and corrected QT dispersion (QTcd) were calculated. RESULTS The mean age of the 250 patients was 37.2±9.3 years and the majority of patients (65%) were male. The mean amount of smoking was 25.74±16.03 packs/year and the mean value of CO was 12.36±7.06 ppm. The mean QTd was 23.83±13.12 ms, and the mean QTcd was 26.63±15.02 ms. A statistically significant relationship was found between QTd and QTcd and level of addiction, consumption of sticks/day and packs/year, and exhaled CO values (all p<0.001). CONCLUSIONS It was found that as the level of addiction, cigarette use amount, exhaled CO levels, and BMI increased in smokers, QT dispersion and arrhythmia risk increased.
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Affiliation(s)
- Gamze Keskin
- Gaziosmanpaşa Training and Research Hospital, Department of Family Medicine, University of Health Sciences, Istanbul, Turkey
| | - Sibel Tunç Karaman
- Gaziosmanpaşa Training and Research Hospital, Department of Family Medicine, University of Health Sciences, Istanbul, Turkey
| | - Okcan Basat
- Gaziosmanpaşa Training and Research Hospital, Department of Family Medicine, University of Health Sciences, Istanbul, Turkey
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Irfan AB, Arab C, DeFilippis AP, Lorkiewicz P, Keith RJ, Xie Z, Bhatnagar A, Carll AP. Smoking Accelerates Atrioventricular Conduction in Humans Concordant with Increased Dopamine Release. Cardiovasc Toxicol 2021; 21:169-178. [PMID: 33043409 PMCID: PMC7855806 DOI: 10.1007/s12012-020-09610-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/01/2020] [Indexed: 01/12/2023]
Abstract
Smoking is associated with cardiac arrhythmia, stroke, heart failure, and sudden cardiac arrest, all of which may derive from increased sympathetic influence on cardiac conduction system and altered ventricular repolarization. However, knowledge of the effects of smoking on supraventricular conduction, and the role of the sympathetic nervous system in them, remains incomplete. Participants with intermediate-high cardiovascular disease risk were measured for urinary catecholamines and cotinine, and 12-lead electrocardiograms (ECGs) were measured for atrial and atrioventricular conduction times, including P duration, PR interval, and PR segment (lead II), which were analyzed for associations with cotinine by generalized linear models. Statistical mediation analyses were then used to test whether any significant associations between cotinine and atrioventricular conduction were mediated by catecholamines. ECG endpoints and urinary metabolites were included from a total of 136 participants in sinus rhythm. Atrial and atrioventricular conduction did not significantly differ between smokers (n = 53) and non-smokers (n = 83). Unadjusted and model-adjusted linear regressions revealed cotinine significantly and inversely associated with PR interval and PR segment, but not P duration. Dopamine, norepinephrine, and epinephrine all inversely associated with PR interval, whereas only dopamine was also inversely associated with PR segment (p < 0.05). Dopamine and norepinephrine (but not epinephrine) also associated positively with cotinine. Dopamine mediated the relationship between cotinine and PR interval, as well as the relationship between cotinine and PR segment. Smoking is associated with accelerated atrioventricular conduction and elevated urinary dopamine and norepinephrine. Smoking may accelerate atrioventricular nodal conduction via increased dopamine production.
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Affiliation(s)
- Affan B Irfan
- Department of Physiology, University of Louisville, Louisville, KY, USA
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
| | - Claudia Arab
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
- Graduate Program in Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | - Andrew P DeFilippis
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association-Tobacco Regulatory and Addiction Center, Dallas, TX, USA
| | - Pawel Lorkiewicz
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association-Tobacco Regulatory and Addiction Center, Dallas, TX, USA
| | - Rachel J Keith
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association-Tobacco Regulatory and Addiction Center, Dallas, TX, USA
| | - Zhengzhi Xie
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association-Tobacco Regulatory and Addiction Center, Dallas, TX, USA
| | - Aruni Bhatnagar
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association-Tobacco Regulatory and Addiction Center, Dallas, TX, USA
| | - Alex P Carll
- Department of Physiology, University of Louisville, Louisville, KY, USA.
- Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA.
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA.
- American Heart Association-Tobacco Regulatory and Addiction Center, Dallas, TX, USA.
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Regencia ZJG, Dalmacion GV, Baja ES. Effect of heavy metals on ventricular repolarization and depolarization in the Metropolitan Manila Development Authority (MMDA) traffic enforcers' health study. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 77:87-95. [PMID: 34027826 DOI: 10.1080/19338244.2020.1853017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We examined the relationships between blood heavy metals [cadmium (B-Cd), mercury (B-Hg), and lead (B-Pb)] and heart rate-corrected QT interval (QTc), JT interval (JTc), and QRS complex duration (QRSc), electrocardiogram markers of ventricular repolarization and depolarization among 60 traffic enforcers in the MMDA traffic enforcers' health study. We fitted regression models to estimate the mean change effect on QTc, JTc, and QRSc, of B-Cd, B-Hg, and B-Pb concentrations, adjusted for potential confounding factors. We looked at effect modification by sex and smoking status. An interquartile range increase in B-Cd (0.9 μg/L) was related to a 6.6% increase in mean QRSc [95% confidence interval (CI): 2.5, 10.8], and a 1.7% increase in mean QTc (95% CI: 0.2, 3.3). We also found that the associations between B-Cd and QRSc and QTc were higher among participants who were never smokers than ever smokers. Moreover, the association between B-Cd and QRSc was also higher among males than females.
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Affiliation(s)
- Zypher Jude G Regencia
- Exposure Assessment, Epidemiology, and Risk Lab, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines-Manila, City of Manila, Philippines
| | - Godofreda V Dalmacion
- Exposure Assessment, Epidemiology, and Risk Lab, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines-Manila, City of Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines-Manila, City of Manila, Philippines
- Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines-Manila, City of Manila, Philippines
| | - Emmanuel S Baja
- Exposure Assessment, Epidemiology, and Risk Lab, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines-Manila, City of Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines-Manila, City of Manila, Philippines
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Ip M, Diamantakos E, Haptonstall K, Choroomi Y, Moheimani RS, Nguyen KH, Tran E, Gornbein J, Middlekauff HR. Tobacco and electronic cigarettes adversely impact ECG indexes of ventricular repolarization: implication for sudden death risk. Am J Physiol Heart Circ Physiol 2020; 318:H1176-H1184. [PMID: 32196360 DOI: 10.1152/ajpheart.00738.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tobacco cigarette smoking is associated with increased sudden death risk, perhaps through adverse effects on ventricular repolarization. The effect of electronic (e-)cigarettes on ventricular repolarization is unknown. The objective of the study was to test the hypothesis that tobacco cigarettes and e-cigarettes have similar adverse effects on electrocardiogram (ECG) indexes of ventricular repolarization and these effects are attributable to nicotine. ECG recordings were obtained in 37 chronic tobacco cigarette smokers, 43 chronic e-cigarette users, and 65 nonusers. Primary outcomes, Tpeak to Tend (Tp-e), Tp-e/QT ratio, and Tp-e/QTc ratio, were measured in tobacco cigarette smokers pre-/post-straw control and smoking one tobacco cigarette and in e-cigarette users and nonusers pre-/post-straw control and using an e-cigarette with and without nicotine (different days). Mean values of the primary outcomes were not different among the three groups at baseline. In chronic tobacco cigarette smokers, all primary outcomes, including the Tp-e (12.9 ± 5.0% vs. 1.5 ± 5%, P = 0.017), Tp-e/QT (14.9 ± 5.0% vs. 0.7 ± 5.1%, P = 0.004), and Tp-e/QTc (11.9 ± 5.0% vs. 2.1 ± 5.1%, P = 0.036), were significantly increased pre-/post-smoking one tobacco cigarette compared with pre-/post-straw control. In chronic e-cigarette users, the Tp-e/QT (6.3 ± 1.9%, P = 0.046) was increased only pre/post using an e-cigarette with nicotine but not pre/post the other exposures. The changes relative to the changes after straw control were greater after smoking the tobacco cigarette compared with using the e-cigarette with nicotine for Tp-e (11.4 ± 4.4% vs. 1.1 ± 2.5%, P < 0.05) and Tp-e/QTc (9.8 ± 4.4% vs. -1.6 ± 2.6%, P = 0.05) but not Tp-e/QT(14.2 ± 4.5% vs. 4.2 ± 2.6%, P = 0.061) . Heart rate increased similarly after the tobacco cigarette and e-cigarette with nicotine. Baseline ECG indexes of ventricular repolarization were not different among chronic tobacco cigarette smokers, electronic cigarette users and nonusers. An adverse effect of acute tobacco cigarette smoking on ECG indexes of ventricular repolarization was confirmed. In chronic e-cigarette users, an adverse effect of using an e-cigarette with nicotine, but not without nicotine, on ECG indexes of ventricular repolarization was also observed.NEW & NOTEWORTHY Abnormal ventricular repolarization, as indicated by prolonged Tpeak-end (Tp-e), is associated with increased sudden death risk. Baseline ECG indexes of repolarization, Tp-e, Tp-e/QT, and Tp-e/QTc, were not different among tobacco cigarette (TC) smokers, electronic cigarette (EC) users, and nonsmokers at baseline, but when TC smokers smoked one TC, all parameters were prolonged. Using an electronic cigarette with nicotine, but not without nicotine, increased the Tp-e/QT. Smoking induces changes in ECG indexes of ventricular repolarization associated with increased sudden death risk.
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Affiliation(s)
- Michelle Ip
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Evangelos Diamantakos
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Kacey Haptonstall
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Yasmine Choroomi
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Roya S Moheimani
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Kevin Huan Nguyen
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Elizabeth Tran
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Jeffrey Gornbein
- Departments of Medicine and Computational Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Holly R Middlekauff
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
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Özdemir L, Sökmen E. Effect of habitual cigarette smoking on the index of cardiac electrophysiological balance in apparently healthy individuals. J Electrocardiol 2020; 59:41-44. [PMID: 31958651 DOI: 10.1016/j.jelectrocard.2020.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Chronic cigarette smoking has been suggested to portend risk for cardiac arrhythmia generation. Index of cardiac electrophysiological balance (iCEB) is a relatively new ECG parameter indicating balance between ventricular depolarization and repolarization, thereby providing more insight concerning ventricular arrhythmogenesis (VA) than other classical ECG parameters such as QT and corrected QT (QTc) intervals. The present study aimed to assess the status of iCEB in healthy habitual smokers. METHODS This retrospective study included a total of 80 apparently healthy subjects (45% female, mean age 39.4 ± 8.1 years) with smoking habit and 82 healthy non-smoking subjects (40% female, mean age 37.0 ± 8.6 years) were included between January-September 2019. Demographic, clinical and ECG characteristics were obtained from medical records. iCEB and corrected iCEB values were calculated by dividing respective QT and QTc intervals by QRS duration. RESULTS Mean PR, QRS and QT intervals were similar between the groups, whereas mean heart rate and QTc interval were greater in the smoker group compared with the non-smokers [(82.0 ± 8.9 bpm vs 77.8 ± 12.4 bpm, respectively, p = 0.016) and (427.05 ± 22.6 msec vs 399.9 ± 12.8 msec, respectively, p < 0.001)]. Subject with smoking habit had greater iCEBc than the controls (5.10 ± 0.49 vs 4.68 ± 0.39, respectively, p < 0.001). However, there was no significant difference in regard of iCEB between the groups (4.37 ± 0.46 vs 4.32 ± 0.42, respectively, p = 0.456). CONCLUSION iCEBc increases significantly in healthy smokers compared with non-smokers. This may suggest an increased predisposition to Torsades de Pointes-mediated VA in healthy smokers, or in chronic smokers with inherent QT-prolonging genetic variations or those on QT-prolonging drug therapy.
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Affiliation(s)
- Levent Özdemir
- Department of Cardiology, Kırşehir Ahi Evran University Education and Research Hospital, Kırşehir, Turkey
| | - Erdoğan Sökmen
- Department of Cardiology, Kırşehir Ahi Evran University Education and Research Hospital, Kırşehir, Turkey.
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Conklin DJ, Schick S, Blaha MJ, Carll A, DeFilippis A, Ganz P, Hall ME, Hamburg N, O'Toole T, Reynolds L, Srivastava S, Bhatnagar A. Cardiovascular injury induced by tobacco products: assessment of risk factors and biomarkers of harm. A Tobacco Centers of Regulatory Science compilation. Am J Physiol Heart Circ Physiol 2019; 316:H801-H827. [PMID: 30707616 PMCID: PMC6483019 DOI: 10.1152/ajpheart.00591.2018] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/09/2019] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
Abstract
Although substantial evidence shows that smoking is positively and robustly associated with cardiovascular disease (CVD), the CVD risk associated with the use of new and emerging tobacco products, such as electronic cigarettes, hookah, and heat-not-burn products, remains unclear. This uncertainty stems from lack of knowledge on how the use of these products affects cardiovascular health. Cardiovascular injury associated with the use of new tobacco products could be evaluated by measuring changes in biomarkers of cardiovascular harm that are sensitive to the use of combustible cigarettes. Such cardiovascular injury could be indexed at several levels. Preclinical changes contributing to the pathogenesis of disease could be monitored by measuring changes in systemic inflammation and oxidative stress, organ-specific dysfunctions could be gauged by measuring endothelial function (flow-mediated dilation), platelet aggregation, and arterial stiffness, and organ-specific injury could be evaluated by measuring endothelial microparticles and platelet-leukocyte aggregates. Classical risk factors, such as blood pressure, circulating lipoproteins, and insulin resistance, provide robust estimates of risk, and subclinical disease progression could be followed by measuring coronary artery Ca2+ and carotid intima-media thickness. Given that several of these biomarkers are well-established predictors of major cardiovascular events, the association of these biomarkers with the use of new and emerging tobacco products could be indicative of both individual and population-level CVD risk associated with the use of these products. Differential effects of tobacco products (conventional vs. new and emerging products) on different indexes of cardiovascular injury could also provide insights into mechanisms by which they induce cardiovascular harm.
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Affiliation(s)
- Daniel J Conklin
- Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky
| | - Suzaynn Schick
- Department of Medicine, University of California-San Francisco , San Francisco, California
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Department of Medicine, Johns Hopkins University , Baltimore, Maryland
| | - Alex Carll
- Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky
| | - Andrew DeFilippis
- Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky
| | - Peter Ganz
- Department of Medicine, University of California-San Francisco , San Francisco, California
| | - Michael E Hall
- Department of Physiology and Biophysics, University of Mississippi Medical Center , Jackson, Mississippi
| | - Naomi Hamburg
- Department of Medicine/Cardiovascular Medicine, School of Medicine, Boston University , Boston, Massachusetts
| | - Tim O'Toole
- Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky
| | - Lindsay Reynolds
- Department of Epidemiology and Prevention, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Sanjay Srivastava
- Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky
| | - Aruni Bhatnagar
- Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky
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12
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Bébarová M, Horáková Z, Kula R. Addictive drugs, arrhythmias, and cardiac inward rectifiers. Europace 2017; 19:346-355. [PMID: 27302393 DOI: 10.1093/europace/euw071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/20/2016] [Indexed: 12/30/2022] Open
Abstract
In many addictive drugs including alcohol and nicotine, proarrhythmic effects were reported. This review provides an overview of the current knowledge in this field (with a focus on the inward rectifier potassium currents) to promote the lacking data and appeal for their completion, thus, to improve understanding of the proarrhythmic potential of addictive drugs.
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13
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Nicotine at clinically relevant concentrations affects atrial inward rectifier potassium current sensitive to acetylcholine. Naunyn Schmiedebergs Arch Pharmacol 2017; 390:471-481. [DOI: 10.1007/s00210-017-1341-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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14
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Akcay A, Aydin MN, Acar G, Mese B, Çetin M, Akgungor M, Cabioglu E, Bozoglan O, Ardic I, Çakici M. Evaluation of left atrial mechanical function and atrial conduction abnormalities in Maras powder (smokeless tobacco) users and smokers. Cardiovasc J Afr 2016; 26:114-9. [PMID: 26592906 PMCID: PMC4538911 DOI: 10.5830/cvja-2014-070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022] Open
Abstract
Objective In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the south-eastern region. Smokeless tobacco is found in preparations for chewing and for absorption by the nasal and oral mucosae. The purpose of this study was to investigate whether MP damages intra- and inter-atrial conduction delay and left atrial (LA) mechanical function as much as cigarette smoking. Method A total of 150 chronic MP users (50 males, 32.5 ± 5.4 years), smokers (50 males, 32.1 ± 6.0 years) and controls (50 males, 30.1 ± 5.8 years) were included in the study. LA volumes were measured echocardiographically according to the biplane area–length method. Atrial electromechanical coupling was measured with tissue Doppler imaging and LA mechanical function parameters were calculated. Results The LA passive emptying fraction was significantly decreased and LA active emptying volume (LAAEV) was significantly increased in the MP group (p = 0.012 and p = 0.024, respectively), and the LA active emptying fraction (LAAEF) was significantly increased in the smokers (p = 0.003). There was a positive correlation between the amount of MP used and smoking (pack years) with LAAEV and LAAEF (r = 0.26, p = 0.009 and r = 0.25, p = 0.013, respectively). Lateral atrial electromechanical intervals (PA) were significantly higher in MP users, and the septal mitral PA was statistically higher in the smokers (p = 0.05 and p = 0.04, respectively). Conclusion We suggest that atrial electromechanical coupling intervals were prolonged and LA mechanical function was impaired in MP users and smokers, but there was no significant difference between the MP users and smokers. These findings may be markers of subclinical cardiac involvement and tendency for atrial fibrillation.
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Affiliation(s)
- Ahmet Akcay
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
| | - M Naci Aydin
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
| | - Gurkan Acar
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
| | - Bulent Mese
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Akgungor
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
| | - Eren Cabioglu
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
| | - Orhan Bozoglan
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Idris Ardic
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
| | - Musa Çakici
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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Taşolar H, Ballı M, Bayramoğlu A, Otlu YÖ, Çetin M, Altun B, Çakıcı M. Effect of Smoking on Tp-e Interval, Tp-e/QT and Tp-e/QTc Ratios as Indices of Ventricular Arrhythmogenesis. Heart Lung Circ 2014; 23:827-32. [PMID: 24746776 DOI: 10.1016/j.hlc.2014.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
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16
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Thomakos P, Liatis S, Kalopita S, Vlahodimitris I, Stathi C, Katsilambros N, Tentolouris N, Makrilakis K. Cigarette Smoking Is Associated with Prolongation of the QTc Interval Duration in Patients with Type 2 Diabetes Mellitus. Int J Endocrinol 2013; 2013:329189. [PMID: 23710173 PMCID: PMC3655597 DOI: 10.1155/2013/329189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/04/2013] [Indexed: 11/21/2022] Open
Abstract
Aims. Aim of the study was to evaluate the effect of smoking on autonomic nervous system (ANS) activity and QTc interval duration in patients with Type 2 diabetes mellitus (T2DM). Methods. A total of 70 patients with T2DM (35 chronic smokers, 35 nonsmokers) treated with oral antidiabetic medications underwent continuous ECG Holter monitoring for 24 hours and analysis of time- and frequency-domain measures of heart rate variability (HRV). HRV over short time was also assessed using the deep breathing test. In addition, baroreflex sensitivity (BRS) was evaluated using the spontaneous sequence method. The mean QTc interval was measured from the 24-hour ECG recordings. Results. Smokers had lower body mass index (BMI) and exhibited higher 24-hour mean heart rate. There was no difference regarding all measures of ANS activity between the two groups. Smokers showed increased mean QTc duration during the 24 hours (439.25 ± 26.95 versus 425.05 ± 23.03 ms, P = 0.021) as well as in both day (439.14 ± 24.31 ms, P = 0.042) and night periods (440.91 ± 32.30 versus 425.51 ± 24.98 ms, P = 0.033). The association between smoking status and mean QTc interval persisted after adjusting for BMI. Conclusions. Cigarette smoking is associated with prolongation of the QTc interval in patients with T2DM by a mechanism independent of ANS dysfunction.
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Affiliation(s)
- Petros Thomakos
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
- *Petros Thomakos:
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
| | - Stavroula Kalopita
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
| | - Ioannis Vlahodimitris
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
| | - Chryssoula Stathi
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
| | - Nicholas Katsilambros
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece
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Coffee, alcohol, smoking, physical activity and QT interval duration: results from the Third National Health and Nutrition Examination Survey. PLoS One 2011; 6:e17584. [PMID: 21386989 PMCID: PMC3046251 DOI: 10.1371/journal.pone.0017584] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/07/2011] [Indexed: 12/31/2022] Open
Abstract
Background Abnormalities in the electrocardiographic QT interval duration have been associated with an increased risk of ventricular arrhythmias and sudden cardiac death. However, there is substantial uncertainty about the effect of modifiable factors such as coffee intake, cigarette smoking, alcohol consumption, and physical activity on QT interval duration. Methods We studied 7795 men and women from the Third National Health and Nutrition Survey (NHANES III, 1988–1994). Baseline QT interval was measured from the standard 12-lead electrocardiogram. Coffee and tea intake, alcohol consumption, leisure-time physical activities over the past month, and lifetime smoking habits were determined using validated questionnaires during the home interview. Results In the fully adjusted model, the average differences in QT interval comparing participants drinking ≥6 cups/day to those who did not drink any were −1.2 ms (95% CI −4.4 to 2.0) for coffee, and −2.0 ms (−11.2 to 7.3) for tea, respectively. The average differences in QT interval duration comparing current to never smokers was 1.2 ms (−0.6 to 2.9) while the average difference in QT interval duration comparing participants drinking ≥7 drinks/week to non-drinkers was 1.8 ms (−0.5 to 4.0). The age, race/ethnicity, and RR-interval adjusted differences in average QT interval duration comparing men with binge drinking episodes to non-drinkers or drinkers without binge drinking were 2.8 ms (0.4 to 5.3) and 4.0 ms (1.6 to 6.4), respectively. The corresponding differences in women were 1.1 (−2.9 to 5.2) and 1.7 ms (−2.3 to 5.7). Finally, the average differences in QT interval comparing the highest vs. the lowest categories of total physical activity was −0.8 ms (−3.0 to 1.4). Conclusion Binge drinking was associated with longer QT interval in men but not in women. QT interval duration was not associated with other modifiable factors including coffee and tea intake, smoking, and physical activity.
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part III: functional biomarkers influenced by smoking. Biomark Med 2010; 3:807-23. [PMID: 20477716 DOI: 10.2217/bmm.09.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Smoking cigarettes induces rapidly occurring and reversible functional changes in the cardiovascular system, which precede morphologic changes. These functional changes are also related to atherosclerotic disease development and thus may qualify as prognostic parameters in chronic smokers. As opposed to smoking-induced morphologic changes functional alterations occur and revert within minutes, thus, allowing for the detection of smoking-induced effects on the cardiovascular system within minutes following exposure to mainstream smoke. Some alterations represent 'direct' changes (e.g., endothelial function), others reflect changes in a different organ system (e.g., the autonomous nervous system influencing heart rate variability), while some represent the sum of alterations in many organs and systems (e.g., exercise performance influenced by the autonomous nervous and by endothelial and cardiac function). Since a specific functional parameter usually changes with at least one or several others, caution should be exercised when trying to establish a direct cause relationship between the alteration of a single parameter and a clinical outcome.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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19
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Dogan EA, Dogan U, Yıldız GU, Akıllı H, Genc E, Genc BO, Gok H. Evaluation of cardiac repolarization indices in well-controlled partial epilepsy: 12-Lead ECG findings. Epilepsy Res 2010; 90:157-63. [DOI: 10.1016/j.eplepsyres.2010.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 04/12/2010] [Accepted: 04/24/2010] [Indexed: 01/10/2023]
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20
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Baja ES, Schwartz JD, Wellenius GA, Coull BA, Zanobetti A, Vokonas PS, Suh HH. Traffic-related air pollution and QT interval: modification by diabetes, obesity, and oxidative stress gene polymorphisms in the normative aging study. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:840-6. [PMID: 20194081 PMCID: PMC2898862 DOI: 10.1289/ehp.0901396] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 03/01/2010] [Indexed: 05/17/2023]
Abstract
BACKGROUND Acute exposure to ambient air pollution has been associated with acute changes in cardiac outcomes, often within hours of exposure. OBJECTIVES We examined the effects of air pollutants on heart-rate-corrected QT interval (QTc), an electrocardiographic marker of ventricular repolarization, and whether these associations were modified by participant characteristics and genetic polymorphisms related to oxidative stress. METHODS We studied repeated measurements of QTc on 580 men from the Veterans Affairs Normative Aging Study (NAS) using mixed-effects models with random intercepts. We fitted a quadratic constrained distributed lag model to estimate the cumulative effect on QTc of ambient air pollutants including fine particulate matter <or= 2.5 microm in aerodynamic diameter (PM2.5), ozone (O3), black carbon (BC), nitrogen dioxide (NO2), carbon monoxide (CO), and sulfur dioxide (SO2) concentrations during the 10 hr before the visit. We genotyped polymorphisms related to oxidative stress and analyzed pollution-susceptibility score interactions using the genetic susceptibility score (GSS) method. RESULTS Ambient traffic pollutant concentrations were related to longer QTc. An interquartile range (IQR) change in BC cumulative during the 10 hr before the visit was associated with increased QTc [1.89 msec change; 95% confidence interval (CI), -0.16 to 3.93]. We found a similar association with QTc for an IQR change in 1-hr BC that occurred 4 hr before the visit (2.54 msec change; 95% CI, 0.28-4.80). We found increased QTc for IQR changes in NO2 and CO, but the change was statistically insignificant. In contrast, we found no association between QTc and PM2.5, SO2, and O3. The association between QTc and BC was stronger among participants who were obese, who had diabetes, who were nonsmokers, or who had higher GSSs. CONCLUSIONS Traffic-related pollutants may increase QTc among persons with diabetes, persons who are obese, and nonsmoking elderly individuals; the number of genetic variants related to oxidative stress increases this effect.
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Affiliation(s)
- Emmanuel S. Baja
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
- Address correspondence to E.S. Baja, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, 401 Park Dr., Suite 422 Landmark Center West, Boston, MA 02115 USA. Telephone: (617) 384-8848. Fax: (617) 384-8745. E-mail:
| | - Joel D. Schwartz
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Brent A. Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Pantel S. Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Internal Medicine, Boston University, Boston, Massachusetts, USA
| | - Helen H. Suh
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
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Lewis MJ, Balaji G, Dixon H, Syed Y, Lewis KE. Influence of smoking abstinence and nicotine replacement therapy on heart rate and QT time-series. Clin Physiol Funct Imaging 2009; 30:43-50. [PMID: 19799615 DOI: 10.1111/j.1475-097x.2009.00902.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
SUMMARY Many smokers attempt to quit without using nicotine replacement therapy (NRT) or pharmacotherapy, i.e. 'cold-turkey'. The cardiac implications of this are important but are incompletely understood. Previous studies have associated smoking cessation with improvements in heart rate (HR) and its variability, but its influence on QT time-series is unclear. Furthermore, the relative influence on these parameters of acute nicotine withdrawal and of NRT has not been adequately compared. Additional insight might come from analysing the dynamic (e.g. fractal) properties of electrocardiographic data during different levels of nicotine exposure. We examined the influence of smoking cessation, during cold-turkey and subsequent NRT, on HR and QT time-series during 30 days of smoking abstinence. Seven smokers and sixteen healthy non-smokers received ECG monitoring at baseline (Day 0). Smokers subsequently refrained from smoking without using NRT for 24 h, and then received NRT for 29 days. ECG monitoring was repeated at Days 1, 7, 30. Following smoking cessation we observed that: HR and rate-corrected QT were both reduced, heart rate variability (HRV) increased (improved), and QT variability index (QTVI) showed signs of improvement (trend only). Improvements in HR and QT were maintained throughout NRT use, whilst improvements in HRV and QTVI were sustained for at least the early stages of NRT. The dynamic (multifractal) properties of HR and QT were similar for smokers and non-smokers, and were unchanged by smoking abstinence or NRT. Our results provide tentative evidence that electrocardiographic improvements during a cold-turkey smoking quit attempt (acute nicotine withdrawal) are maintained during NRT pharmacotherapy.
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Affiliation(s)
- M J Lewis
- School of Engineering, Swansea University, Wales, UK.
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22
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Li J, Huo Y, Zhang Y, Fang Z, Yang J, Zang T, Xu X, Xu X. Familial aggregation and heritability of electrocardiographic intervals and heart rate in a rural Chinese population. Ann Noninvasive Electrocardiol 2009; 14:147-52. [PMID: 19419399 DOI: 10.1111/j.1542-474x.2009.00289.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Estimates of the genetic influences on electrocardiographic (ECG) parameters are inconsistent in previous reports, and no such studies have been performed in China. So we estimated genetic contributions to PR and QRS intervals and the rate-adjusted QT interval (Bazett's QTc) in a Chinese rural population. METHODS A total of 2909 subjects from 847 families were enrolled in the current study. Genetic contributions to ECG parameters were estimated in two ways: correlation coefficients among family members (father-mother, parent-offspring, first sibling-other sibling) and the heritability of each of the ECG parameters. RESULTS Our results showed significant correlations among family members on theses parameters: the correlation coefficients for PR interval, QRS duration, QTc interval, and HR, between parent-sibling, and sibling-sibling were 0.17 and 0.13, 0.18 and 0.23, 0.22 and 0.28, 0.19 and 0.18, respectively. The heritability for PR interval, QRS duration, QTc interval, and HR were estimated as 0.34, 0.43, 0.40, and 0.34, respectively. CONCLUSION Genetic factors, together with the environmental and other cofactors contribute no more than 60% to the variance of the ECG intervals, supporting the concept that multiple factors, including gene-gene and gene-environment interactions could influence ECG interval phenotypes, and genetic factors play a major role.
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Affiliation(s)
- Jianping Li
- Peking University First Hospital, Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 8 Xishiku St., Xicheng District, Beijing, China.
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Abstract
Prolonged QT interval is associated with the generation of life-threatening arrhythmias and sudden death. However, neither the relation between QT duration and heart rate, nor the association between mental stress and QT time has been clarified. Aim: The relationship between QT duration and smoking, cardiovascular reactivity, and mental stress as well as newer methods of QT correction were studied. Methods: In six laboratory experiments 166 volunteers were studied. Smoking, treadmill exercise, mental arithmetic and videogame were applied as stressors. Besides fixed formulae, study and subject-specific QT correction methods were also used. Results: 1. Bazett formula is not appropriate to compare QT durations. 2. Acute smoking has no effect on QT time. 3. QT changes are related to cardiovascular reactivity. 4. Mental stress may induce QT prolongation. 5. Bifid T waves often develop during mental and isometric stress. Conclusions: New methods for QT correction are more reliable than preformed formulae. QT prolongation and bifid T waves may be the links between mental stress and life threatening arrhythmias.
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Affiliation(s)
- Gábor Andrássy
- Budapesti Szent Ferenc Kórház Budapest Széher u. 73. 1021
- Semmelweis Egyetem Elméleti Orvostudományok Doktori Iskola Budapest
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Ilgenli TF, Congologlu A, Ozturk C, Turkbay T, Akpinar O, Kilicaslan F. Acute effect of methylphenidate on QT interval duration and dispersion in children with attention deficit hyperactivity disorder. Adv Ther 2007; 24:182-8. [PMID: 17526476 DOI: 10.1007/bf02850007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Among childhood psychiatric disorders, attention deficit hyperactivity disorder (ADHD) is of greatest interest to practitioners. Methylphenidate (MPH) is a drug that is widely used in the treatment of children in whom ADHD has been diagnosed. Although this treatment has been used for years, its effects on the heart remain the subject of debate. The QT interval comprises the ventricular activation and recovery periods as seen on electrocardiogram (ECG). The acute effect of MPH on QT interval dispersion is unknown. Researchers in the present study sought to investigate the acute effects of MPH on QT interval as seen on ECG. A total of 25 patients with ADHD (mean age, 9.4+/-2.1 y) who were treated with MPH were enrolled in the study. Twelve-lead derivation ECGs were taken before and 2 h after administration of 10 mg of MPH. Maximum QT interval, minimum QT interval, and interval durations were measured, and QT dispersion was calculated, for each ECG. QT dispersion measured after medication administration decreased significantly from 59.6+/-16.3 ms to 50.8+/-10.9 ms (P=.016); corrected QT dispersion decreased significantly from 70.9+/-17.6 ms to 61.3+/-13.3 ms (P=.011). Maximum QT interval duration decreased from 73.7+/-21.8 ms to 361.8+/-29.0 ms (P=.006); minimum QT interval duration rose from 317.0+/-23.3 ms to 322.3+/-21.6 ms (P=.312). In conclusion, the findings of this study show that MPH reduces QT dispersion during the acute period shortly after its administration.
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Affiliation(s)
- T Fikret Ilgenli
- Department of Cardiology, Golcuk Army Hospital, Golcuk, Kocaeli, Turkey.
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Andrássy G, Szabo A, Dunai A, Simon E, Nagy T, Trummer Z, Tahy A, Varro A. Acute effects of cigarette smoking on the QT interval in healthy smokers. Am J Cardiol 2003; 92:489-92. [PMID: 12914890 DOI: 10.1016/s0002-9149(03)00678-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study assesses the effect of a first cigarette smoked in the morning on the QT interval duration in healthy habitual smokers after not smoking overnight. This study demonstrates that although after cigarette smoking the QT(Bc) values increase, the QT(Fc) and QT(Lc) values remained unchanged, and an increased sympathetic response was evident. The discrepancies between the results seen by different QT correction formulas emphasize the importance of selecting an accurate method for heart rate correction when evaluating and interpreting alterations in QT values.
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Affiliation(s)
- Gábor Andrássy
- Kardiológiai Osztály, Szent Ferenc Kórház, Budapest, Hungary.
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