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Couch LS, Thomas KE, Marin F, Terentes-Printzios D, Kotronias RA, Chai J, Lukaschuk E, Shanmuganathan M, Kellman P, Langrish JP, Channon KM, Neubauer S, Piechnik SK, Ferreira VM, de Maria GL, Banning AP. The Role of Coronary Blood Flow and Myocardial Edema in the Pathophysiology of Takotsubo Syndrome. JACC Cardiovasc Imaging 2024:S1936-878X(24)00112-8. [PMID: 38573286 DOI: 10.1016/j.jcmg.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 04/05/2024]
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Rigler C, Menon G, Lipworth S, Langrish JP, Kipps C, Shanmuganathan M, Smith R. Erratum to "Case Series of Triathletes with Takotsubo Cardiomyopathy Presenting with Swimming-Induced Pulmonary Edema". Transl Sports Med 2023; 2023:9858459. [PMID: 38654912 PMCID: PMC11022756 DOI: 10.1155/2023/9858459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/04/2023] [Indexed: 04/26/2024]
Abstract
[This corrects the article DOI: 10.1155/2022/3602505.].
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Affiliation(s)
- Caitlin Rigler
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Gautam Menon
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Samuel Lipworth
- Emergency Department, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jeremy P. Langrish
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Courtney Kipps
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Mayooran Shanmuganathan
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ralph Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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Kotronias RA, Marin F, Emfietzoglou M, Langrish JP, Lucking AJ, Channon KM, Banning AP, De Maria GL. Rationale and Design of a Randomized Controlled Pilot Trial to Assess Stent Retriever Thrombectomy for Thrombus Burden Reduction in Patients with Acute Myocardial Infarction: The RETRIEVE-AMI Study. Cardiovasc Revasc Med 2023; 52:75-85. [PMID: 36894360 DOI: 10.1016/j.carrev.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) is typically caused by thrombotic occlusion of a coronary artery with subsequent hypoperfusion and myocardial necrosis. In approximately half of patients with STEMI, despite successful restoration of epicardial coronary patency, downstream myocardium perfusion remains impeded. Coronary microvascular injury is one of the key mechanisms behind suboptimal myocardial perfusion and it is primarily, yet not exclusively, related to distal embolization of atherothrombotic material following recanalization of the culprit artery. Routine manual thrombus-aspiration has failed to show clinical efficacy in this scenario. This could be related with limitations in technology adopted as well as patients' selection. To this end, we set out to explore the efficacy and safety of stent retriever-assisted thrombectomy based on clot-removal device routinely used in stroke intervention. STUDY DESIGN AND OBJECTIVES The stent RETRIEVEr thrombectomy for thrombus burden reduction in patients with Acute Myocardial Infarction (RETRIEVE-AMI) study has been designed to establish whether stent retriever-based thrombectomy is safe and more efficacious in thrombus modification than the current standard of care: manual thrombus aspiration or stenting. The RETRIEVE-AMI trial will enrol 81 participants admitted for primary PCI for inferior STEMI. Participants will be 1:1:1 randomised to receive either standalone PCI, thrombus aspiration and PCI, or retriever-based thrombectomy and PCI. Change in thrombus burden will be assessed via optical coherence tomography imaging. A telephone follow-up at 6 months will be arranged. CONCLUSIONS It is anticipated by the investigators that stent retriever thrombectomy will more effectively reduce the thrombotic burden compared to current standard of care whilst being clinically safe.
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Affiliation(s)
- Rafail A Kotronias
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Federico Marin
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Maria Emfietzoglou
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeremy P Langrish
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew J Lucking
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Keith M Channon
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.
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Rigler C, Menon G, Lipworth S, Langrish JP, Kipps C, Shanmuganathan M, Smith R. Case Series of Triathletes with Takotsubo Cardiomyopathy Presenting with Swimming-Induced Pulmonary Edema. Transl Sports Med 2022; 2022:3602505. [PMID: 38655156 PMCID: PMC11022776 DOI: 10.1155/2022/3602505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/09/2022] [Indexed: 04/26/2024]
Abstract
Objectives To report three cases of triathletes who presented with swimming-induced pulmonary edema (SIPE) following water immersion. They were subsequently diagnosed with Takotsubo cardiomyopathy (TCM). Design Retrospective case series. Method All cases were recreational athletes competing in mass participation triathlons between June 2018 and 2019. They were initially managed by the event medical team and subsequently at the local tertiary level hospital. Written consent was gained from all the subjects. Results The three triathletes were aged between 50 and 60 years, two were females, and all presented with acute dyspnoea on exiting the water. Two also presented with chest pain and haemoptysis. A diagnosis of SIPE was suspected by the medical event team on initial presentation of low oxygen saturations and clinical signs of pulmonary oedema. All were transferred to the local emergency department and had signs of pulmonary oedema on chest radiographs. Further investigations led to a diagnosis of TCM with findings of T wave inversion in anterolateral electrocardiogram leads and apical hypokinesia on transthoracic echocardiogram and unobstructed coronary arteries. Conclusions This case series presents triathletes diagnosed with SIPE and TCM following the open water swim phase. It is unclear whether the myocardial dysfunction contributed to causation of SIPE or was the result of SIPE. Mass participation race organizers must be prepared that both SIPE and TCM can present in this population. Those presenting with an episode of SIPE require prompt evaluation of their cardiac and pulmonary physiology. Further research is required to ascertain the exact nature of the relationship between TCM and SIPE.
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Affiliation(s)
- Caitlin Rigler
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Gautam Menon
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Samuel Lipworth
- Emergency Department, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jeremy P Langrish
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Courtney Kipps
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Mayooran Shanmuganathan
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ralph Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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Kotronias RA, Terentes-Printzios D, Shanmuganathan M, Marin F, Scarsini R, Bradley-Watson J, Langrish JP, Lucking AJ, Choudhury R, Kharbanda RK, Garcia-Garcia HM, Channon KM, Banning AP, De Maria GL. Long-Term Clinical Outcomes in Patients With an Acute ST-Segment-Elevation Myocardial Infarction Stratified by Angiography-Derived Index of Microcirculatory Resistance. Front Cardiovasc Med 2021; 8:717114. [PMID: 34557531 PMCID: PMC8452918 DOI: 10.3389/fcvm.2021.717114] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
Aims: Despite the prognostic value of coronary microvascular dysfunction (CMD) in patients with ST-segment-elevation myocardial infarction (STEMI), its assessment with pressure-wire-based methods remains limited due to cost, technical and procedural complexities. The non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMRangio) has been shown to reliably predict microvascular injury in patients with STEMI. We investigated the prognostic potential of NH IMRangio as a pressure-wire and adenosine-free tool. Methods and Results: NH IMRangio was retrospectively derived on the infarct-related artery at completion of primary percutaneous coronary intervention (pPCI) in 262 prospectively recruited STEMI patients. Invasive pressure-wire-based assessment of the index of microcirculatory resistance (IMR) was performed. The combination of all-cause mortality, resuscitated cardiac arrest and new heart failure was the primary endpoint. NH IMRangio showed good diagnostic performance in identifying CMD (IMR > 40U); AUC 0.78 (95%CI: 0.72–0.84, p < 0.0001) with an optimal cut-off at 43U. The primary endpoint occurred in 38 (16%) patients at a median follow-up of 4.2 (2.0–6.5) years. On survival analysis, NH IMRangio > 43U (log-rank test, p < 0.001) was equivalent to an IMR > 40U(log-rank test, p = 0.02) in predicting the primary endpoint (hazard ratio comparison p = 0.91). NH IMRangio > 43U was an independent predictor of the primary endpoint (adjusted HR 2.13, 95% CI: 1.01–4.48, p = 0.047). Conclusion: NH IMRangio is prognostically equivalent to invasively measured IMR and can be a feasible alternative to IMR for risk stratification in patients presenting with STEMI.
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Affiliation(s)
- Rafail A Kotronias
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | - Mayooran Shanmuganathan
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom.,OCMR, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Federico Marin
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Roberto Scarsini
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom.,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - James Bradley-Watson
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Jeremy P Langrish
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew J Lucking
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Robin Choudhury
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Rajesh K Kharbanda
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | - Keith M Channon
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
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Scarsini R, Shanmuganathan M, Kotronias RA, Terentes-Printzios D, Borlotti A, Langrish JP, Lucking AJ, Ribichini F, Ferreira VM, Channon KM, Garcia-Garcia HM, Banning AP, De Maria GL. Angiography-derived index of microcirculatory resistance (IMRangio) as a novel pressure-wire-free tool to assess coronary microvascular dysfunction in acute coronary syndromes and stable coronary artery disease. Int J Cardiovasc Imaging 2021; 37:1801-1813. [DOI: 10.1007/s10554-021-02254-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/23/2021] [Indexed: 01/04/2023]
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De Maria GL, Scarsini R, Shanmuganathan M, Kotronias RA, Terentes-Printzios D, Borlotti A, Langrish JP, Lucking AJ, Choudhury RP, Kharbanda R, Ferreira VM, Channon KM, Garcia-Garcia HM, Banning AP. Angiography-derived index of microcirculatory resistance as a novel, pressure-wire-free tool to assess coronary microcirculation in ST elevation myocardial infarction. Int J Cardiovasc Imaging 2020; 36:1395-1406. [PMID: 32409977 PMCID: PMC7381481 DOI: 10.1007/s10554-020-01831-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
Immediate assessment of coronary microcirculation during treatment of ST elevation myocardial infarction (STEMI) may facilitate patient stratification for targeted treatment algorithms. Use of pressure-wire to measure the index of microcirculatory resistance (IMR) is possible but has inevitable practical restrictions. We aimed to develop and validate angiography-derived index of microcirculatory resistance (IMRangio) as a novel and pressure-wire-free index to facilitate assessment of the coronary microcirculation. 45 STEMI patients treated with primary percutaneous coronary intervention (pPCI) were enrolled. Immediately before stenting and at completion of pPCI, IMR was measured within the infarct related artery (IRA). At the same time points, 2 angiographic views were acquired during hyperaemia to measure quantitative flow ratio (QFR) from which IMRangio was derived. In a subset of 15 patients both IMR and IMRangio were also measured in the non-IRA. Patients underwent cardiovascular magnetic resonance imaging (CMR) at 48 h for assessment of microvascular obstruction (MVO). IMRangio and IMR were significantly correlated (ρ: 0.85, p < 0.001). Both IMR and IMRangio were higher in the IRA rather than in the non-IRA (p = 0.01 and p = 0.006, respectively) and were higher in patients with evidence of clinically significant MVO (> 1.55% of left ventricular mass) (p = 0.03 and p = 0.005, respectively). Post-pPCI IMRangio presented and area under the curve (AUC) of 0.96 (CI95% 0.92–1.00, p < 0.001) for prediction of post-pPCI IMR > 40U and of 0.81 (CI95% 0.65–0.97, p < 0.001) for MVO > 1.55%. IMRangio is a promising tool for the assessment of coronary microcirculation. Assessment of IMR without the use of a pressure-wire may enable more rapid, convenient and cost-effective assessment of coronary microvascular function.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Roberto Scarsini
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Mayooran Shanmuganathan
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK.,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
| | - Rafail A Kotronias
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Dimitrios Terentes-Printzios
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Alessandra Borlotti
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Jeremy P Langrish
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Andrew J Lucking
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Robin P Choudhury
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Rajesh Kharbanda
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | - Vanessa M Ferreira
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK.,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
| | | | - Keith M Channon
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK
| | | | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK.
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Fan L, Lucking AJ, Kelion A, Sabharwal N, Langrish JP. Aortic Pseudoaneurysm With Compression of Left Main Stem Following Aortic Valve Replacement. Can J Cardiol 2020; 36:968.e9-968.e11. [PMID: 32360172 DOI: 10.1016/j.cjca.2020.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lampson Fan
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Andrew J Lucking
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Andrew Kelion
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nikant Sabharwal
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeremy P Langrish
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
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Alkhalil M, Borlotti A, De Maria GL, Wolfrum M, Dawkins S, Fahrni G, Gaughran L, Langrish JP, Lucking A, Ferreira VM, Kharbanda RK, Banning AP, Dall'Armellina E, Channon KM, Choudhury RP. Hyper-acute cardiovascular magnetic resonance T1 mapping predicts infarct characteristics in patients with ST elevation myocardial infarction. J Cardiovasc Magn Reson 2020; 22:3. [PMID: 31915031 PMCID: PMC6951001 DOI: 10.1186/s12968-019-0593-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Myocardial recovery after primary percutaneous coronary intervention in acute myocardial infarction is variable and the extent and severity of injury are difficult to predict. We sought to investigate the role of cardiovascular magnetic resonance T1 mapping in the determination of myocardial injury very early after treatment of ST-segment elevation myocardial infarction (STEMI). METHODS STEMI patients underwent 3 T cardiovascular magnetic resonance (CMR), within 3 h of primary percutaneous intervention (PPCI). T1 mapping determined the extent (area-at-risk as %left ventricle, AAR) and severity (average T1 values of AAR) of acute myocardial injury, and related these to late gadolinium enhancement (LGE), and microvascular obstruction (MVO). The characteristics of myocardial injury within 3 h was compared with changes at 24-h to predict final infarct size. RESULTS Forty patients were included in this study. Patients with average T1 values of AAR ≥1400 ms within 3 h of PPCI had larger LGE at 24-h (33% ±14 vs. 18% ±10, P = 0.003) and at 6-months (27% ±9 vs. 12% ±9; P < 0.001), higher incidence and larger extent of MVO (85% vs. 40%, P = 0.016) & [4.0 (0.5-9.5)% vs. 0 (0-3.0)%, P = 0.025]. The average T1 value was an independent predictor of acute LGE (β 0.61, 95%CI 0.13 to 1.09; P = 0.015), extent of MVO (β 0.22, 95%CI 0.03 to 0.41, P = 0.028) and final infarct size (β 0.63, 95%CI 0.21 to 1.05; P = 0.005). Receiver-operating-characteristic analysis showed that T1 value of AAR obtained within 3-h, but not at 24-h, predicted large infarct size (LGE > 9.5%) with 100% positive predictive value at the optimal cut-off of 1400 ms (area-under-the-curve, AUC 0.88, P = 0.006). CONCLUSION Hyper-acute T1 values of the AAR (within 3 h post PPCI, but not 24 h) predict a larger extent of MVO and infarct size at both 24 h and 6 months follow-up. Delayed CMR scanning for 24 h could not substitute the significant value of hyper-acute average T1 in determining infarct characteristics.
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Affiliation(s)
- Mohammad Alkhalil
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alessandra Borlotti
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Mathias Wolfrum
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Sam Dawkins
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Gregor Fahrni
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Lisa Gaughran
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jeremy P Langrish
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Andrew Lucking
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Rajesh K Kharbanda
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Erica Dall'Armellina
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Keith M Channon
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Robin P Choudhury
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK.
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.
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10
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Scarsini R, De Maria GL, Borlotti A, Kotronias RA, Langrish JP, Lucking AJ, Choudhury RP, Ferreira VM, Ribichini F, Channon KM, Kharbanda RK, Banning AP. Incremental Value of Coronary Microcirculation Resistive Reserve Ratio in Predicting the Extent of Myocardial Infarction in Patients with STEMI. Insights from the Oxford Acute Myocardial Infarction (OxAMI) Study. Cardiovascular Revascularization Medicine 2019; 20:1148-1155. [DOI: 10.1016/j.carrev.2019.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/04/2023]
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11
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Krasopoulos G, D'Alessio A, Verdichizzo D, Muretti M, Turton MJ, Gerry S, Trivella M, Keiralla A, Lucking A, Langrish JP. Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery. J Card Surg 2019; 35:304-312. [PMID: 31765036 DOI: 10.1111/jocs.14366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Arterial graft physiology influences the long-term outcome of coronary artery bypass grafting (CABG). We studied factors that can affect the overall resistance to flow using internal mammary artery grafting to the left anterior descending artery. METHODS This was a prospective, nonrandomized observational study of 100 consecutive patients who underwent elective on-pump isolated or combined valve surgery and CABG. Coronary stenoses were assessed using conventional and quantitative coronary angiography assessment. The flow and pulsatility index (PI) of the grafts were assessed by transit-time flowmetry during cardioplegic arrest and at the end of the operation. Fractional polynomials were used to explore linearity, followed by multivariable regression analysis. RESULTS Univariate analysis demonstrated higher flows at the end of the operation in patients who had higher flows with the cross-clamp on (P < .001), in males (P = .004), in patients with a low PI at the end of the operation (P = .04), and in patients with a larger size of the recipient artery (P = .005). Multivariable regression analysis showed that the graft flow at the end of the operation was significantly associated with the mean flow with the cross-clamp on (P < .001), sex (P = .003), and PI at the end of the operation (P = .003). Concomitant valve surgery did not influence flows. Male patients had 18 mL/min higher flow. CONCLUSIONS The graft flow at the end of the operation can be determined by the flow with the cross-clamp on, the PI with the cross-clamp off and coronary artery. We reported differences in the graft flows between sexes, and for first the time, we introduced the concepts of "adequate flow" and "resistance-to-forward-flow" for patent coronary grafts.
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Affiliation(s)
- George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Department of Cardiothoracic Surgery, University of Oxford, Oxford, United Kingdom
| | - Andrea D'Alessio
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Danilo Verdichizzo
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mirko Muretti
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael J Turton
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Stephen Gerry
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Marialena Trivella
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Amar Keiralla
- Department of Cardiac Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Andrew Lucking
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jeremy P Langrish
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Kotronias RA, Scarsini R, Gibbs T, De Maria GL, Rajasundaram S, Langrish JP, Lucking AJ, Channon KM, Kharbanda RK, Banning AP. Safety of Rotational Atherectomy Using the Radial Access in Patients With Severe Aortic Stenosis. Am J Cardiol 2019; 124:381-388. [PMID: 31174836 DOI: 10.1016/j.amjcard.2019.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 01/22/2023]
Abstract
Despite frequent percutaneous coronary intervention (PCI) in calcified vessels of older patients, rotational atherectomy (RA) has not been endorsed in patients with severe aortic stenosis (AS) due to safety concerns and lack of data. We explored periprocedural safety and mortality in severe AS patients undergoing RA. Prospective anonymized clinical, echocardiographic, procedural and outcome data of patients undergoing RA PCI between January 2012 and July 2018 were retrospectively extracted from the institutional coronary database. Patients with severe AS undergoing RA PCI were 1:1 propensity matched with patients undergoing RA PCI in the absence of AS. Outcomes of interest were RA related periprocedural complications, 30-day and 1-year mortality. A prespecified subgroup analysis examined the influence of transcatheter aortic valve replacement on mortality following RA PCI. A total of 544 patients underwent RA PCI; 478 without AS and 66 with AS. Propensity matching yielded 35 matched pairs with improved balance in covariates of interest and no significant differences in baseline characteristics postmatching. In the matched cohort (n = 70) slow flow/no-reflow, coronary dissection, perforation, and hemodynamic instability were rare and not significantly different. Survival analyses revealed significantly higher 30-day (Log-Rank p = 0.02) and 1-year mortality (Log rank p = 0.02, HR 5.24 [95% CI 1.13 to 24.28]) in the severe AS group; driven by a fivefold increase in the hazard of death among patients who did not undergo transcatheter aortic valve replacement HR 4.98 [95% CI 1.03 to 24.1]. In conclusion, our study of 70 patients undergoing radial RA PCI suggests that it can be safely performed in patients with severe AS. Long-term outcomes after RA in patients with severe AS are determined by the presence of the valve disease and other co-morbidities.
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De Maria GL, Alkhalil M, Wolfrum M, Fahrni G, Borlotti A, Gaughran L, Dawkins S, Langrish JP, Lucking AJ, Choudhury RP, Porto I, Crea F, Dall'Armellina E, Channon KM, Kharbanda RK, Banning AP. Index of Microcirculatory Resistance as a Tool to Characterize Microvascular Obstruction and to Predict Infarct Size Regression in Patients With STEMI Undergoing Primary PCI. JACC Cardiovasc Imaging 2019; 12:837-848. [PMID: 29680355 DOI: 10.1016/j.jcmg.2018.02.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study aimed to compare the value of the index of microcirculatory resistance (IMR) and microvascular obstruction (MVO) measured by cardiac magnetic resonance (CMR) in patients treated for and recovering from ST-segment elevation myocardial infarction. BACKGROUND IMR can identify patients with microvascular dysfunction acutely after primary percutaneous coronary intervention (pPCI), and a threshold of >40 has been shown to be associated with an adverse clinical outcome. Similarly, MVO is recognized as an adverse feature in patients with ST-segment elevation myocardial infarction. Even though both IMR and MVO reflect coronary microvascular status, the interaction between these 2 parameters is uncertain. METHODS A total of 110 patients treated with pPCI were included, and IMR was measured immediately at completion of pPCI. Infarct size (IS) as a percentage of left ventricular mass was quantified at 48 h (38.4 ± 12.0 h) and 6 months (194.0 ± 20.0 days) using CMR. MVO was identified and quantified at 48 h by CMR. RESULTS Overall, a discordance between IMR and MVO was observed in 36.7% of cases, with 31 patients having MVO and IMR ≤40. Compared with patients with MVO and IMR ≤40, patients with both MVO and IMR >40 had an 11.9-fold increased risk of final IS >25% at 6 months (p = 0.001). Patients with MVO and IMR ≤40 had a significantly smaller IS at 6 months (p = 0.001), with significant regression in IS over time (34.4% [interquartile range (IQR): 27.3% to 41.0%] vs. 22.3% [IQR: 16.0% to 30.0%]; p = 0.001). CONCLUSIONS Discordant prognostic information was obtained from IMR and MVO in nearly one-third of cases; however, IMR can be helpful in grading the degree and severity of MVO.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mohammad Alkhalil
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Mathias Wolfrum
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Gregor Fahrni
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Alessandra Borlotti
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Lisa Gaughran
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Sam Dawkins
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Jeremy P Langrish
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew J Lucking
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Department of Cardiology, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Italo Porto
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Filippo Crea
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Erica Dall'Armellina
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Keith M Channon
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Rajesh K Kharbanda
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom.
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De Maria GL, Alkhalil M, Borlotti A, Wolfrum M, Gaughran L, Dall'Armellina E, Langrish JP, Lucking AJ, Choudhury RP, Kharbanda RK, Channon KM, Banning AP. Index of microcirculatory resistance-guided therapy with pressure-controlled intermittent coronary sinus occlusion improves coronary microvascular function and reduces infarct size in patients with ST-elevation myocardial infarction: the Oxford Acute Myocardial Infarction - Pressure-controlled Intermittent Coronary Sinus Occlusion study (OxAMI-PICSO study). EUROINTERVENTION 2018; 14:e352-e359. [PMID: 29792403 DOI: 10.4244/eij-d-18-00378] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
AIMS The Oxford Acute Myocardial Infarction PICSO (OxAMI-PICSO) study aimed to assess the efficacy of index of microcirculatory resistance (IMR)-guided therapy with pressure-controlled intermittent coronary sinus occlusion (PICSO) in anterior ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS Patients with anterior STEMI treated with primary percutaneous coronary intervention (pPCI) were enrolled. Pre-stenting IMR was measured and PICSO treatment delivered if pre-stenting IMR was >40. No PICSO treatment was considered in patients with a pre-stenting IMR ≤40. The control group was derived from a historical cohort of STEMI patients with pre-stenting IMR >40 enrolled in the observational OxAMI study. IMR was measured after completion of pPCI in all patients and within 48 hours in PICSO patients and controls. Cardiac magnetic resonance imaging was performed per protocol for infarct size (IS) assessment within 48 hours after pPCI and at six months. A total of 105 patients were enrolled (25 PICSO, 50 controls with pre-stenting IMR >40, 30 with pre-stenting IMR ≤40). Compared to controls, patients treated with PICSO had a lower IMR at 24-48 hours (24.8 [18.5-35.9] vs. 45.0 [32.0-51.3], p<0.001) and lower IS at six months (26.0% [20.2-30.0] vs. 33.0% [28.0-37.0], p=0.006). CONCLUSIONS An IMR-guided treatment with PICSO in anterior STEMI is feasible and may be associated with reduced IS and improved microvascular function.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
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15
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Dawkins S, Alkhalil M, De Maria GL, Fahrni G, Kassimis G, Lee R, Patel N, Banning AP, Choudhury RP, Forfar C, Kharbanda R, Langrish JP, Lucking AJ, Channon KM. Improved Coronary Sinus Blood Sampling for Cardiac Research. Exp Clin Cardiol 2018. [DOI: 10.4172/2155-9880.1000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Miller MR, Raftis JB, Langrish JP, McLean SG, Samutrtai P, Connell SP, Wilson S, Vesey AT, Fokkens PHB, Boere AJF, Krystek P, Campbell CJ, Hadoke PWF, Donaldson K, Cassee FR, Newby DE, Duffin R, Mills NL. Correction to"Inhaled Nanoparticles Accumulate at Sites of Vascular Disease". ACS Nano 2017; 11:10623-10624. [PMID: 28976185 PMCID: PMC8504789 DOI: 10.1021/acsnano.7b06327] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Indexed: 05/21/2023]
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Miller MR, Raftis JB, Langrish JP, McLean SG, Samutrtai P, Connell SP, Wilson S, Vesey AT, Fokkens PHB, Boere AJF, Krystek P, Campbell CJ, Hadoke PWF, Donaldson K, Cassee FR, Newby DE, Duffin R, Mills NL. Inhaled Nanoparticles Accumulate at Sites of Vascular Disease. ACS Nano 2017; 11:4542-4552. [PMID: 28443337 PMCID: PMC5444047 DOI: 10.1021/acsnano.6b08551] [Citation(s) in RCA: 334] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/24/2017] [Indexed: 05/18/2023]
Abstract
The development of engineered nanomaterials is growing exponentially, despite concerns over their potential similarities to environmental nanoparticles that are associated with significant cardiorespiratory morbidity and mortality. The mechanisms through which inhalation of nanoparticles could trigger acute cardiovascular events are emerging, but a fundamental unanswered question remains: Do inhaled nanoparticles translocate from the lung in man and directly contribute to the pathogenesis of cardiovascular disease? In complementary clinical and experimental studies, we used gold nanoparticles to evaluate particle translocation, permitting detection by high-resolution inductively coupled mass spectrometry and Raman microscopy. Healthy volunteers were exposed to nanoparticles by acute inhalation, followed by repeated sampling of blood and urine. Gold was detected in the blood and urine within 15 min to 24 h after exposure, and was still present 3 months after exposure. Levels were greater following inhalation of 5 nm (primary diameter) particles compared to 30 nm particles. Studies in mice demonstrated the accumulation in the blood and liver following pulmonary exposure to a broader size range of gold nanoparticles (2-200 nm primary diameter), with translocation markedly greater for particles <10 nm diameter. Gold nanoparticles preferentially accumulated in inflammation-rich vascular lesions of fat-fed apolipoproteinE-deficient mice. Furthermore, following inhalation, gold particles could be detected in surgical specimens of carotid artery disease from patients at risk of stroke. Translocation of inhaled nanoparticles into the systemic circulation and accumulation at sites of vascular inflammation provides a direct mechanism that can explain the link between environmental nanoparticles and cardiovascular disease and has major implications for risk management in the use of engineered nanomaterials.
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Affiliation(s)
- Mark R. Miller
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
- E-mail:
| | - Jennifer B. Raftis
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Jeremy P. Langrish
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Steven G. McLean
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Pawitrabhorn Samutrtai
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Shea P. Connell
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Simon Wilson
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Alex T. Vesey
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Paul H. B. Fokkens
- National
Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - A. John F. Boere
- National
Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Petra Krystek
- Department
of Environment and Health, VU University, 1081 HV Amsterdam, The Netherlands
| | - Colin J. Campbell
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Patrick W. F. Hadoke
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Ken Donaldson
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Flemming R. Cassee
- National
Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
- Institute
for Risk Assessment Sciences, Utrecht University, 3512 JE Utrecht, The Netherlands
| | - David E. Newby
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Rodger Duffin
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Nicholas L. Mills
- BHF Centre for Cardiovascular Science, MRC Centre for Inflammation
Research, and EaStCHEM School
of Chemistry, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
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Hunter AL, Shah ASV, Langrish JP, Raftis JB, Lucking AJ, Brittan M, Venkatasubramanian S, Stables CL, Stelzle D, Marshall J, Graveling R, Flapan AD, Newby DE, Mills NL. Fire Simulation and Cardiovascular Health in Firefighters. Circulation 2017; 135:1284-1295. [PMID: 28373523 PMCID: PMC5377985 DOI: 10.1161/circulationaha.116.025711] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rates of myocardial infarction in firefighters are increased during fire suppression duties, and are likely to reflect a combination of factors including extreme physical exertion and heat exposure. We assessed the effects of simulated fire suppression on measures of cardiovascular health in healthy firefighters. METHODS In an open-label randomized crossover study, 19 healthy firefighters (age, 41±7 years; 16 males) performed a standardized training exercise in a fire simulation facility or light duties for 20 minutes. After each exposure, ex vivo thrombus formation, fibrinolysis, platelet activation, and forearm blood flow in response to intra-arterial infusions of endothelial-dependent and -independent vasodilators were measured. RESULTS After fire simulation training, core temperature increased (1.0±0.1°C) and weight reduced (0.46±0.14 kg, P<0.001 for both). In comparison with control, exposure to fire simulation increased thrombus formation under low-shear (73±14%) and high-shear (66±14%) conditions (P<0.001 for both) and increased platelet-monocyte binding (7±10%, P=0.03). There was a dose-dependent increase in forearm blood flow with all vasodilators (P<0.001), which was attenuated by fire simulation in response to acetylcholine (P=0.01) and sodium nitroprusside (P=0.004). This was associated with a rise in fibrinolytic capacity, asymptomatic myocardial ischemia, and an increase in plasma cardiac troponin I concentrations (1.4 [0.8-2.5] versus 3.0 [1.7-6.4] ng/L, P=0.010). CONCLUSIONS Exposure to extreme heat and physical exertion during fire suppression activates platelets, increases thrombus formation, impairs vascular function, and promotes myocardial ischemia and injury in healthy firefighters. Our findings provide pathogenic mechanisms to explain the association between fire suppression activity and acute myocardial infarction in firefighters. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01812317.
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Affiliation(s)
- Amanda L Hunter
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Anoop S V Shah
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Jeremy P Langrish
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Jennifer B Raftis
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Andrew J Lucking
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Mairi Brittan
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Sowmya Venkatasubramanian
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Catherine L Stables
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Dominik Stelzle
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - James Marshall
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Richard Graveling
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Andrew D Flapan
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - David E Newby
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Nicholas L Mills
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.).
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Venkatasubramanian S, Noh RM, Daga S, Langrish JP, Mills NL, Waterhouse BR, Hoffmann E, Jacobson EW, Lang NN, Frier BM, Newby DE. Effects of the small molecule SIRT1 activator, SRT2104 on arterial stiffness in otherwise healthy cigarette smokers and subjects with type 2 diabetes mellitus. Open Heart 2016; 3:e000402. [PMID: 27239324 PMCID: PMC4879341 DOI: 10.1136/openhrt-2016-000402] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/09/2016] [Accepted: 04/13/2016] [Indexed: 11/24/2022] Open
Abstract
Objective Arterial stiffness increases with age, and is associated with adverse cardiovascular outcome including increased mortality. The effect of the oral small molecule SIRT1 activator, SRT2104, on arterial stiffness was examined in otherwise healthy cigarette smokers and participants with type 2 diabetes mellitus. Methods 24 otherwise healthy cigarette smokers and 15 people with stable type 2 diabetes were randomised in a double-blind placebo-controlled crossover trial and received 28 days of oral SRT2104 (2.0 g/day) or matched placebo. Blood pressure was measured using non-invasive oscillatory sphygmomanometry. Pulse wave analysis and velocity were measured using applanation tonometry at baseline and the end of each treatment period. Owing to the small sample size and similar trends for both groups, data for the two groups were pooled (post hoc analysis). Results Compared to placebo, treatment with SRT2104 was associated with a significant reduction in augmentation pressure (p=0.0273) and a trend towards improvement in the augmentation index and corrected augmentation index (p>0.05 for both). However, no changes were observed in pulse wave velocity and time to wave reflection (p>0.05). Systolic and diastolic blood pressures remained unchanged throughout the study. Treatment by cohort interaction was not significant for any of the pulse wave parameters, suggesting that the response to SRT2104 in otherwise healthy smokers and people with diabetes was consistent. Conclusions SRT2104 may improve measures of arterial stiffness in otherwise healthy cigarette smokers and in participants with type 2 diabetes. Definitive conclusions are not possible given the small sample size and exploratory nature of this analysis. Trial registration number NCT01031108.
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Affiliation(s)
| | - Radzi M Noh
- Department of Diabetes , Royal Infirmary , Edinburgh , UK
| | | | - Jeremy P Langrish
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - Nicholas L Mills
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | | | | | | | - Ninian N Lang
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - Brian M Frier
- Department of Diabetes , Royal Infirmary , Edinburgh , UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
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Langrish JP, Bosson JA, Sandström T, Blomberg A, Newby DE, Mills NL. Atmospheric interactions and cardiac arrhythmias: Langrish et al. respond. Environ Health Perspect 2015; 123:A144-A145. [PMID: 26029956 PMCID: PMC4455597 DOI: 10.1289/ehp.1409636r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Jeremy P Langrish
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
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Shah ASV, Lee KK, McAllister DA, Hunter A, Nair H, Whiteley W, Langrish JP, Newby DE, Mills NL. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ 2015; 350:h1295. [PMID: 25810496 PMCID: PMC4373601 DOI: 10.1136/bmj.h1295] [Citation(s) in RCA: 460] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review the evidence for the short term association between air pollution and stroke. DESIGN Systematic review and meta-analysis of observational studies DATA SOURCES Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions. ELIGIBILITY CRITERIA Studies investigating the short term associations (up to lag of seven days) between daily increases in gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate matter (<2.5 µm or <10 µm diameter (PM2.5 and PM10)), and admission to hospital for stroke or mortality. MAIN OUTCOME MEASURES Admission to hospital and mortality from stroke. RESULTS From 2748 articles, 238 were reviewed in depth with 103 satisfying our inclusion criteria and 94 contributing to our meta-estimates. This provided a total of 6.2 million events across 28 countries. Admission to hospital for stroke or mortality from stroke was associated with an increase in concentrations of carbon monoxide (relative risk 1.015 per 1 ppm, 95% confidence interval 1.004 to 1.026), sulphur dioxide (1.019 per 10 ppb, 1.011 to 1.027), and nitrogen dioxide (1.014 per 10 ppb, 1.009 to 1.019). Increases in PM2.5 and PM10 concentration were also associated with admission and mortality (1.011 per 10 μg/m(3) (1.011 to 1.012) and 1.003 per 10 µg/m(3) (1.002 to 1.004), respectively). The weakest association was seen with ozone (1.001 per 10 ppb, 1.000 to 1.002). Strongest associations were observed on the day of exposure with more persistent effects observed for PM(2·5). CONCLUSION Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42014009225.
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Affiliation(s)
- Anoop S V Shah
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Kuan Ken Lee
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David A McAllister
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Amanda Hunter
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Harish Nair
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jeremy P Langrish
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
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Hunter AL, Unosson J, Bosson JA, Langrish JP, Pourazar J, Raftis JB, Miller MR, Lucking AJ, Boman C, Nyström R, Donaldson K, Flapan AD, Shah ASV, Pung L, Sadiktsis I, Masala S, Westerholm R, Sandström T, Blomberg A, Newby DE, Mills NL. Effect of wood smoke exposure on vascular function and thrombus formation in healthy fire fighters. Part Fibre Toxicol 2014; 11:62. [PMID: 25487196 PMCID: PMC4338635 DOI: 10.1186/s12989-014-0062-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/30/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Myocardial infarction is the leading cause of death in fire fighters and has been linked with exposure to air pollution and fire suppression duties. We therefore investigated the effects of wood smoke exposure on vascular vasomotor and fibrinolytic function, and thrombus formation in healthy fire fighters. METHODS In a double-blind randomized cross-over study, 16 healthy male fire fighters were exposed to wood smoke (~1 mg/m³ particulate matter concentration) or filtered air for one hour during intermittent exercise. Arterial pressure and stiffness were measured before and immediately after exposure, and forearm blood flow was measured during intra-brachial infusion of endothelium-dependent and -independent vasodilators 4-6 hours after exposure. Thrombus formation was assessed using the ex vivo Badimon chamber at 2 hours, and platelet activation was measured using flow cytometry for up to 24 hours after the exposure. RESULTS Compared to filtered air, exposure to wood smoke increased blood carboxyhaemoglobin concentrations (1.3% versus 0.8%; P < 0.001), but had no effect on arterial pressure, augmentation index or pulse wave velocity (P > 0.05 for all). Whilst there was a dose-dependent increase in forearm blood flow with each vasodilator (P < 0.01 for all), there were no differences in blood flow responses to acetylcholine, sodium nitroprusside or verapamil between exposures (P > 0.05 for all). Following exposure to wood smoke, vasodilatation to bradykinin increased (P = 0.003), but there was no effect on bradykinin-induced tissue-plasminogen activator release, thrombus area or markers of platelet activation (P > 0.05 for all). CONCLUSIONS Wood smoke exposure does not impair vascular vasomotor or fibrinolytic function, or increase thrombus formation in fire fighters. Acute cardiovascular events following fire suppression may be precipitated by exposure to other air pollutants or through other mechanisms, such as strenuous physical exertion and dehydration.
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Affiliation(s)
- Amanda L Hunter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Jon Unosson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Jenny A Bosson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Jeremy P Langrish
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Jamshid Pourazar
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | | | - Mark R Miller
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Andrew J Lucking
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Christoffer Boman
- Thermochemical Energy Conversion Laboratory, Umeå University, Umeå, Sweden.
| | - Robin Nyström
- Thermochemical Energy Conversion Laboratory, Umeå University, Umeå, Sweden.
| | | | - Andrew D Flapan
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Anoop S V Shah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Louis Pung
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Ioannis Sadiktsis
- Department of Analytical Chemistry, Stockholm University, Stockholm, Sweden.
| | - Silvia Masala
- Department of Analytical Chemistry, Stockholm University, Stockholm, Sweden.
| | - Roger Westerholm
- Department of Analytical Chemistry, Stockholm University, Stockholm, Sweden.
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Langrish JP, Watts SJ, Hunter AJ, Shah ASV, Bosson JA, Unosson J, Barath S, Lundbäck M, Cassee FR, Donaldson K, Sandström T, Blomberg A, Newby DE, Mills NL. Controlled exposures to air pollutants and risk of cardiac arrhythmia. Environ Health Perspect 2014; 122:747-53. [PMID: 24667535 PMCID: PMC4080532 DOI: 10.1289/ehp.1307337] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 03/21/2014] [Indexed: 05/03/2023]
Abstract
BACKGROUND Epidemiological studies have reported associations between air pollution exposure and increases in cardiovascular morbidity and mortality. Exposure to air pollutants can influence cardiac autonomic tone and reduce heart rate variability, and may increase the risk of cardiac arrhythmias, particularly in susceptible patient groups. OBJECTIVES We investigated the incidence of cardiac arrhythmias during and after controlled exposure to air pollutants in healthy volunteers and patients with coronary heart disease. METHODS We analyzed data from 13 double-blind randomized crossover studies including 282 participants (140 healthy volunteers and 142 patients with stable coronary heart disease) from whom continuous electrocardiograms were available. The incidence of cardiac arrhythmias was recorded for each exposure and study population. RESULTS There were no increases in any cardiac arrhythmia during or after exposure to dilute diesel exhaust, wood smoke, ozone, concentrated ambient particles, engineered carbon nanoparticles, or high ambient levels of air pollution in either healthy volunteers or patients with coronary heart disease. CONCLUSIONS Acute controlled exposure to air pollutants did not increase the short-term risk of arrhythmia in participants. Research employing these techniques remains crucial in identifying the important pathophysiological pathways involved in the adverse effects of air pollution, and is vital to inform environmental and public health policy decisions.
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Affiliation(s)
- Jeremy P Langrish
- University of Edinburgh, University/BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
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Chin CWL, Shah ASV, McAllister DA, Joanna Cowell S, Alam S, Langrish JP, Strachan FE, Hunter AL, Maria Choy A, Lang CC, Walker S, Boon NA, Newby DE, Mills NL, Dweck MR. High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis. Eur Heart J 2014; 35:2312-21. [PMID: 24829362 PMCID: PMC4156973 DOI: 10.1093/eurheartj/ehu189] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims High-sensitivity cardiac troponin I (cTnI) assays hold promise in detecting the transition from hypertrophy to heart failure in aortic stenosis. We sought to investigate the mechanism for troponin release in patients with aortic stenosis and whether plasma cTnI concentrations are associated with long-term outcome. Methods and results Plasma cTnI concentrations were measured in two patient cohorts using a high-sensitivity assay. First, in the Mechanism Cohort, 122 patients with aortic stenosis (median age 71, 67% male, aortic valve area 1.0 ± 0.4 cm2) underwent cardiovascular magnetic resonance and echocardiography to assess left ventricular (LV) myocardial mass, function, and fibrosis. The indexed LV mass and measures of replacement fibrosis (late gadolinium enhancement) were associated with cTnI concentrations independent of age, sex, coronary artery disease, aortic stenosis severity, and diastolic function. In the separate Outcome Cohort, 131 patients originally recruited into the Scottish Aortic Stenosis and Lipid Lowering Trial, Impact of REgression (SALTIRE) study, had long-term follow-up for the occurrence of aortic valve replacement (AVR) and cardiovascular deaths. Over a median follow-up of 10.6 years (1178 patient-years), 24 patients died from a cardiovascular cause and 60 patients had an AVR. Plasma cTnI concentrations were associated with AVR or cardiovascular death HR 1.77 (95% CI, 1.22 to 2.55) independent of age, sex, systolic ejection fraction, and aortic stenosis severity. Conclusions In patients with aortic stenosis, plasma cTnI concentration is associated with advanced hypertrophy and replacement myocardial fibrosis as well as AVR or cardiovascular death.
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Affiliation(s)
- Calvin W L Chin
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK National Heart Center Singapore, Singapore
| | - Anoop S V Shah
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | | | - S Joanna Cowell
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Shirjel Alam
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Jeremy P Langrish
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Fiona E Strachan
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Amanda L Hunter
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Anna Maria Choy
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, UK
| | - Chim C Lang
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, UK
| | - Simon Walker
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, UK
| | - Nicholas A Boon
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Nicholas L Mills
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Marc R Dweck
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
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Langrish JP, Miller M, Raftis J, Donaldson K, Cassee FR, Newby D, Duffin R, Mills N. TRANSLOCATION AND ACCUMULATION OF INHALED GOLD NANOPARTICLES IN ATHEROSCLEROTIC PLAQUE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)62120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Muala A, Sehlstedt M, Bion A, Österlund C, Bosson JA, Behndig AF, Pourazar J, Bucht A, Boman C, Mudway IS, Langrish JP, Couderc S, Blomberg A, Sandström T. Assessment of the capacity of vehicle cabin air inlet filters to reduce diesel exhaust-induced symptoms in human volunteers. Environ Health 2014; 13:16. [PMID: 24621126 PMCID: PMC4007775 DOI: 10.1186/1476-069x-13-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/05/2014] [Indexed: 05/05/2023]
Abstract
BACKGROUND Exposure to particulate matter (PM) air pollution especially derived from traffic is associated with increases in cardiorespiratory morbidity and mortality. In this study, we evaluated the ability of novel vehicle cabin air inlet filters to reduce diesel exhaust (DE)-induced symptoms and markers of inflammation in human subjects. METHODS Thirty healthy subjects participated in a randomized double-blind controlled crossover study where they were exposed to filtered air, unfiltered DE and DE filtered through two selected particle filters, one with and one without active charcoal. Exposures lasted for one hour. Symptoms were assessed before and during exposures and lung function was measured before and after each exposure, with inflammation assessed in peripheral blood five hours after exposures. In parallel, PM were collected from unfiltered and filtered DE and assessed for their capacity to drive damaging oxidation reactions in a cell-free model, or promote inflammation in A549 cells. RESULTS The standard particle filter employed in this study reduced PM10 mass concentrations within the exposure chamber by 46%, further reduced to 74% by the inclusion of an active charcoal component. In addition use of the active charcoal filter was associated by a 75% and 50% reduction in NO2 and hydrocarbon concentrations, respectively. As expected, subjects reported more subjective symptoms after exposure to unfiltered DE compared to filtered air, which was significantly reduced by the filter with an active charcoal component. There were no significant changes in lung function after exposures. Similarly diesel exhaust did not elicit significant increases in any of the inflammatory markers examined in the peripheral blood samples 5 hour post-exposure. Whilst the filters reduced chamber particle concentrations, the oxidative activity of the particles themselves, did not change following filtration with either filter. In contrast, diesel exhaust PM passed through the active charcoal combination filter appeared less inflammatory to A549 cells. CONCLUSIONS A cabin air inlet particle filter including an active charcoal component was highly effective in reducing both DE particulate and gaseous components, with reduced exhaust-induced symptoms in healthy volunteers. These data demonstrate the effectiveness of cabin filters to protect subjects travelling in vehicles from diesel exhaust emissions.
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Affiliation(s)
- Ala Muala
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Maria Sehlstedt
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Anne Bion
- Renault Technocentre, Guyancourt, France
| | - Camilla Österlund
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
- Swedish Defence Research Agency, FOI, Umeå, Sweden
| | - Jenny A Bosson
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Annelie F Behndig
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Jamshid Pourazar
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Anders Bucht
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
- Swedish Defence Research Agency, FOI, Umeå, Sweden
| | - Christoffer Boman
- Department of Applied Physics and Electronics, Thermochemical Energy Conversion Laboratory, Umeå University, Umeå, Sweden
| | - Ian S Mudway
- MRC-PHE Centre for Environment and Health, School of Biomedical Sciences, King’s College London, London, UK
| | - Jeremy P Langrish
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
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Affiliation(s)
- Jeremy P Langrish
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Nicholas L Mills
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SB, UK.
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Unosson J, Blomberg A, Sandström T, Kabele M, Boman C, Lucking AJ, Mills NL, Newby DE, Langrish JP, Bosson JA. PM276 Biodiesel Exhaust Exposure Causes Vascular Dysfunction In Healthy Subjects. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
BACKGROUND Acute exposure to air pollution has been linked to myocardial infarction, but its effect on heart failure is uncertain. We did a systematic review and meta-analysis to assess the association between air pollution and acute decompensated heart failure including hospitalisation and heart failure mortality. METHODS Five databases were searched for studies investigating the association between daily increases in gaseous (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate (diameter <2·5 μm [PM2·5] or <10 μm [PM10]) air pollutants, and heart failure hospitalisations or heart failure mortality. We used a random-effects model to derive overall risk estimates per pollutant. FINDINGS Of 1146 identified articles, 195 were reviewed in-depth with 35 satisfying inclusion criteria. Heart failure hospitalisation or death was associated with increases in carbon monoxide (3·52% per 1 part per million; 95% CI 2·52-4·54), sulphur dioxide (2·36% per 10 parts per billion; 1·35-3·38), and nitrogen dioxide (1·70% per 10 parts per billion; 1·25-2·16), but not ozone (0·46% per 10 parts per billion; -0·10 to 1·02) concentrations. Increases in particulate matter concentration were associated with heart failure hospitalisation or death (PM2·5 2·12% per 10 μg/m(3), 95% CI 1·42-2·82; PM10 1·63% per 10 μg/m(3), 95% CI 1·20-2·07). Strongest associations were seen on the day of exposure, with more persistent effects for PM2·5. In the USA, we estimate that a mean reduction in PM2·5 of 3·9 μg/m(3) would prevent 7978 heart failure hospitalisations and save a third of a billion US dollars a year. INTERPRETATION Air pollution has a close temporal association with heart failure hospitalisation and heart failure mortality. Although more studies from developing nations are required, air pollution is a pervasive public health issue with major cardiovascular and health economic consequences, and it should remain a key target for global health policy. FUNDING British Heart Foundation.
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Affiliation(s)
- Anoop SV Shah
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Jeremy P Langrish
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Harish Nair
- Centre of Population Health Sciences, University of Edinburgh, UK
- Public Health Foundation of India, New Delhi, India
| | | | - Amanda L Hunter
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Ken Donaldson
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, UK
- Correspondence to: Dr Nicholas L Mills, BHF/University Centre for Cardiovascular Science, University of Edinburgh Chancellor's Building, Edinburgh, EH16 4SB, UK
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Donaldson K, Duffin R, Langrish JP, Miller MR, Mills NL, Poland CA, Raftis J, Shah A, Shaw CA, Newby DE. Nanoparticles and the cardiovascular system: a critical review. Nanomedicine (Lond) 2013; 8:403-23. [PMID: 23477334 DOI: 10.2217/nnm.13.16] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Nanoparticles (NPs) are tiny particles with a diameter of less than 100 nm. Traffic exhaust is a major source of combustion-derived NPs (CDNPs), which represent a significant component in urban air pollution. Epidemiological, panel and controlled human chamber studies clearly demonstrate that exposure to CDNPs is associated with multiple adverse cardiovascular effects in both healthy individuals and those with pre-existing cardiovascular disease. NPs are also manufactured from a large range of materials for industrial use in a vast array of products including for use as novel imaging agents for medical use. There is currently little information available on the impacts of manufactured NPs in humans, but experimental studies demonstrate similarities to the detrimental cardiovascular actions of CDNPs. This review describes the evidence for these cardiovascular effects and attempts to resolve the paradox between the adverse effects of the unintentional exposure of CDNPs and the intentional delivery of manufactured NPs for medical purposes.
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Affiliation(s)
- Ken Donaldson
- Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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Barath S, Langrish JP, Lundbäck M, Bosson JA, Goudie C, Newby DE, Sandström T, Mills NL, Blomberg A. Short-term exposure to ozone does not impair vascular function or affect heart rate variability in healthy young men. Toxicol Sci 2013; 135:292-9. [PMID: 23872581 PMCID: PMC3807622 DOI: 10.1093/toxsci/kft157] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Air pollution exposure is associated with cardiovascular morbidity and mortality, yet the role of individual pollutants remains unclear. In particular, there is uncertainty regarding the acute effect of ozone exposure on cardiovascular disease. In these studies, we aimed to determine the effect of ozone exposure on vascular function, fibrinolysis, and the autonomic regulation of the heart. Thirty-six healthy men were exposed to ozone (300 ppb) and filtered air for 75min on two occasions in randomized double-blind crossover studies. Bilateral forearm blood flow (FBF) was measured using forearm venous occlusion plethysmography before and during intra-arterial infusions of vasodilators 2–4 and 6–8h after each exposure. Heart rhythm and heart rate variability (HRV) were monitored during and 24h after exposure. Compared with filtered air, ozone exposure did not alter heart rate, blood pressure, or resting FBF at either 2 or 6h. There was a dose-dependent increase in FBF with all vasodilators that was similar after both exposures at 2–4h. Ozone exposure did not impair vasomotor or fibrinolytic function at 6–8h but rather increased vasodilatation to acetylcholine (p = .015) and sodium nitroprusside (p = .005). Ozone did not affect measures of HRV during or after the exposure. Our findings do not support a direct rapid effect of ozone on vascular function or cardiac autonomic control although we cannot exclude an effect of chronic exposure or an interaction between ozone and alternative air pollutants that may be responsible for the adverse cardiovascular health effects attributed to ozone.
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Affiliation(s)
- Stefan Barath
- * Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
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Venkatasubramanian S, Noh RM, Daga S, Langrish JP, Joshi NV, Mills NL, Hoffmann E, Jacobson EW, Vlasuk GP, Waterhouse BR, Lang NN, Newby DE. Cardiovascular effects of a novel SIRT1 activator, SRT2104, in otherwise healthy cigarette smokers. J Am Heart Assoc 2013; 2:e000042. [PMID: 23770971 PMCID: PMC3698759 DOI: 10.1161/jaha.113.000042] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND We examined the effect of the oral SIRT1 activator SRT2104 on cardiovascular function in otherwise healthy cigarette smokers. METHODS AND RESULTS Twenty-four otherwise healthy cigarette smokers participated in a randomized double-blind, placebo-controlled crossover trial and received 28 days of oral SRT2104 (2.0 g/day) or matched placebo. Plasma SRT2104 concentrations, serum lipid profile, plasma fibrinolytic factors, and markers of platelet and monocyte activation were measured at baseline and at the end of each treatment period together with an assessment of forearm blood flow during intra-arterial bradykinin, acetylcholine, and sodium nitroprusside infusions. Three hours postdose, mean plasma SRT2104 concentration was 1328 ± 748 ng/mL after 28 days of active treatment. Compared with placebo, serum lipid profile improved during SRT2104 administration, with reductions in serum total cholesterol (-11.6 ± 20 versus 6 ± 21 mg/dL), low-density lipoprotein cholesterol (-10 ± 17 versus 3 ± 21 mg/dL), and triglyceride (-39.8 ± 77 versus 13.3 ± 57 mg/dL) concentrations (P<0.05 for all). All vasodilators produced a dose-dependent increase in blood flow (P<0.0001) that was similar during each treatment period (P>0.05 for all). No significant differences in fibrinolytic or blood flow parameters were observed between placebo and SRT2014. CONCLUSIONS SRT2104 appears to be safe and well tolerated and associated with an improved lipid profile without demonstrable differences in vascular or platelet function in otherwise healthy cigarette smokers. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT01031108.
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Unosson J, Blomberg A, Sandström T, Muala A, Boman C, Nyström R, Westerholm R, Mills NL, Newby DE, Langrish JP, Bosson JA. Exposure to wood smoke increases arterial stiffness and decreases heart rate variability in humans. Part Fibre Toxicol 2013; 10:20. [PMID: 23742058 PMCID: PMC3685524 DOI: 10.1186/1743-8977-10-20] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/23/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Emissions from biomass combustion are a major source of indoor and outdoor air pollution, and are estimated to cause millions of premature deaths worldwide annually. Whilst adverse respiratory health effects of biomass exposure are well established, less is known about its effects on the cardiovascular system. In this study we assessed the effect of exposure to wood smoke on heart rate, blood pressure, central arterial stiffness and heart rate variability in otherwise healthy persons. METHODS Fourteen healthy non-smoking subjects participated in a randomized, double-blind crossover study. Subjects were exposed to dilute wood smoke (mean particle concentration of 314±38 μg/m3) or filtered air for three hours during intermittent exercise. Heart rate, blood pressure, central arterial stiffness and heart rate variability were measured at baseline and for one hour post-exposure. RESULTS Central arterial stiffness, measured as augmentation index, augmentation pressure and pulse wave velocity, was higher after wood smoke exposure as compared to filtered air (p < 0.01 for all), and heart rate was increased (p < 0.01) although there was no effect on blood pressure. Heart rate variability (SDNN, RMSSD and pNN50; p = 0.003, p < 0.001 and p < 0.001 respectively) was decreased one hour following exposure to wood smoke compared to filtered air. CONCLUSIONS Acute exposure to wood smoke as a model of exposure to biomass combustion is associated with an immediate increase in central arterial stiffness and a simultaneous reduction in heart rate variability. As biomass is used for cooking and heating by a large fraction of the global population and is currently advocated as a sustainable alternative energy source, further studies are required to establish its likely impact on cardiovascular disease. TRIAL REGISTRATION ClinicalTrials.gov, NCT01488500.
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Shah AS, Alam S, Cowell J, McAllister D, Dweck M, Langrish JP, Carter E, Stoddart M, Hunter A, Joshi N, Boon N, Newby D, Mills NL. HIGH SENSITIVE TROPONIN PREDICTS LONG–TERM PROGNOSIS IN PATIENTS WITH AORTIC STENOSIS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Langrish JP, Unosson J, Bosson J, Barath S, Muala A, Blackwell S, Söderberg S, Pourazar J, Megson IL, Treweeke A, Sandström T, Newby DE, Blomberg A, Mills NL. Altered nitric oxide bioavailability contributes to diesel exhaust inhalation-induced cardiovascular dysfunction in man. J Am Heart Assoc 2013; 2:e004309. [PMID: 23525434 PMCID: PMC3603248 DOI: 10.1161/jaha.112.004309] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Diesel exhaust inhalation causes cardiovascular dysfunction including impaired vascular reactivity, increased blood pressure, and arterial stiffness. We investigated the role of nitric oxide (NO) bioavailability in mediating these effects. Methods and Results In 2 randomized double‐blind crossover studies, healthy nonsmokers were exposed to diesel exhaust or filtered air. Study 1: Bilateral forearm blood flow was measured during intrabrachial infusions of acetylcholine (ACh; 5 to 20 μg/min) and sodium nitroprusside (SNP; 2 to 8 μg/min) in the presence of the NO clamp (NO synthase inhibitor NG‐monomethyl‐l‐arginine (l‐NMMA) 8 μg/min coinfused with the NO donor SNP at 90 to 540 ng/min to restore basal blood flow). Study 2: Blood pressure, arterial stiffness, and cardiac output were measured during systemic NO synthase inhibition with intravenous l‐NMMA (3 mg/kg). Following diesel exhaust inhalation, plasma nitrite concentrations were increased (68±48 versus 41±32 nmol/L; P=0.006) despite similar l‐NMMA–induced reductions in basal blood flow (−20.6±14.7% versus −21.1±14.6%; P=0.559) compared to air. In the presence of the NO clamp, ACh and SNP caused dose‐dependent vasodilatation that was not affected by diesel exhaust inhalation (P>0.05 for both). Following exposure to diesel exhaust, l‐NMMA caused a greater increase in blood pressure (P=0.048) and central arterial stiffness (P=0.007), but reductions in cardiac output and increases in systemic vascular resistance (P>0.05 for both) were similar to those seen with filtered air. Conclusions Diesel exhaust inhalation disturbs normal vascular homeostasis with enhanced NO generation unable to compensate for excess consumption. We suggest the adverse cardiovascular effects of air pollution are, in part, mediated through reduced NO bioavailability. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT00845767 and NCT01060930.
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Affiliation(s)
- Jeremy P Langrish
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Miller MR, Shaw CA, Langrish JP. From particles to patients: oxidative stress and the cardiovascular effects of air pollution. Future Cardiol 2012; 8:577-602. [PMID: 22871197 DOI: 10.2217/fca.12.43] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Air pollution, especially airborne particulate matter (PM), is associated with an increase in both morbidity and mortality from cardiovascular disease, although the underlying mechanisms remain incompletely established. The one consistent observation that links the pulmonary and cardiovascular effects of inhaled PM is oxidative stress. This article examines the evidence for the role of oxidative stress in the cardiovascular effects of air pollution, beginning with observations from epidemiological and controlled exposure studies and then exploring potential mechanistic pathways involving free radical generation from PM itself, to effects of PM on cell cultures, isolated organs, healthy animals and animal models of disease. Particular emphasis is placed on the vascular and atherosclerotic effects of urban air pollution and diesel exhaust emissions as rich sources of environmental ultrafine particles.
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Affiliation(s)
- Mark R Miller
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, Scotland, UK.
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Langrish JP, Bosson J, Unosson J, Muala A, Newby DE, Mills NL, Blomberg A, Sandström T. Cardiovascular effects of particulate air pollution exposure: time course and underlying mechanisms. J Intern Med 2012; 272:224-39. [PMID: 22724512 DOI: 10.1111/j.1365-2796.2012.02566.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Air pollution is now recognized as an important independent risk factor for cardiovascular morbidity and mortality and may be responsible for up to 3 million premature deaths each year worldwide. The mechanisms underlying the observed effects are poorly understood but are likely to be multifactorial. Here, we review the acute and chronic effects of air pollution exposure on the cardiovascular system and discuss how these effects may explain the observed increases in cardiovascular morbidity and mortality.
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Affiliation(s)
- J P Langrish
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Shah ASV, Langrish JP, Li X, Jiang L, Newby DE, Mills NL. 141 Cardiac troponin reflects silent myocardial ischaemia in patients with stable coronary artery disease. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Shah AS, Langrish JP, Li X, Jiang L, Newby DE, Mills NL. CARDIAC TROPONIN REFLECTS SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61416-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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40
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Langrish JP, Li X, Wang S, Lee MMY, Barnes GD, Miller MR, Cassee FR, Boon NA, Donaldson K, Li J, Li L, Mills NL, Newby DE, Jiang L. Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease. Environ Health Perspect 2012; 120:367-72. [PMID: 22389220 PMCID: PMC3295351 DOI: 10.1289/ehp.1103898] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 01/03/2012] [Indexed: 04/14/2023]
Abstract
BACKGROUND Air pollution exposure increases cardiovascular morbidity and mortality and is a major global public health concern. OBJECTIVES We investigated the benefits of reducing personal exposure to urban air pollution in patients with coronary heart disease. METHODS In an open randomized crossover trial, 98 patients with coronary heart disease walked on a predefined route in central Beijing, China, under different conditions: once while using a highly efficient face mask, and once while not using the mask. Symptoms, exercise, personal air pollution exposure, blood pressure, heart rate, and 12-lead electrocardiography were monitored throughout the 24-hr study period. RESULTS Ambient air pollutants were dominated by fine and ultrafine particulate matter (PM) that was present at high levels [74 μg/m³ for PM(2.5) (PM with aerodynamic diamater <2.5 µm)]. Consistent with traffic-derived sources, this PM contained organic carbon and polycyclic aromatic hydrocarbons and was highly oxidizing, generating large amounts of free radicals. The face mask was well tolerated, and its use was associated with decreased self-reported symptoms and reduced maximal ST segment depression (-142 vs. -156 μV, p = 0.046) over the 24-hr period. When the face mask was used during the prescribed walk, mean arterial pressure was lower (93 ± 10 vs. 96 ± 10 mmHg, p = 0.025) and heart rate variability increased (high-frequency power: 54 vs. 40 msec², p = 0.005; high-frequency normalized power: 23.5 vs. 20.5 msec, p = 0.001; root mean square successive differences: 16.7 vs. 14.8 msec, p = 0.007). However, mask use did not appear to influence heart rate or energy expenditure. CONCLUSIONS Reducing personal exposure to air pollution using a highly efficient face mask appeared to reduce symptoms and improve a range of cardiovascular health measures in patients with coronary heart disease. Such interventions to reduce personal exposure to PM air pollution have the potential to reduce the incidence of cardiovascular events in this highly susceptible population.
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Affiliation(s)
- Jeremy P Langrish
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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Richards JMJ, Semple SI, MacGillivray TJ, Gray C, Langrish JP, Williams M, Dweck M, Wallace W, McKillop G, Chalmers RTA, Garden OJ, Newby DE. Abdominal aortic aneurysm growth predicted by uptake of ultrasmall superparamagnetic particles of iron oxide: a pilot study. Circ Cardiovasc Imaging 2011; 4:274-81. [PMID: 21304070 DOI: 10.1161/circimaging.110.959866] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abdominal aortic aneurysms are a major cause of death. Prediction of aneurysm expansion and rupture is challenging and currently relies on the simple measure of aneurysm diameter. Using MRI, we aimed to assess whether areas of cellular inflammation correlated with the rate of abdominal aortic aneurysm expansion. METHODS AND RESULTS Stable patients (n=29; 27 male; age, 70±5 years) with asymptomatic abdominal aortic aneurysms (4.0 to 6.6 cm) were recruited from a surveillance program and imaged using a 3-T MRI scanner before and 24 to 36 hours after administration of ultrasmall superparamagnetic particles of iron oxide (USPIO). The change in T2* value on T2*-weighted imaging was used to detect accumulation of USPIO within the abdominal aortic aneurysm. Histological examination of aneurysm tissue confirmed colocalization and uptake of USPIO in areas with macrophage infiltration. Patients with distinct mural uptake of USPIO had a 3-fold higher growth rate (n=11, 0.66 cm/y; P=0.020) than those with no (n=6, 0.22 cm/y) or nonspecific USPIO uptake (n=8, 0.24 cm/y) despite having similar aneurysm diameters (5.4±0.6, 5.1±0.5, and 5.0±0.5 cm, respectively; P>0.05). In 1 patient with an inflammatory aneurysm, there was a strong and widespread uptake of USPIO extending beyond the aortic wall. CONCLUSIONS Uptake of USPIO in abdominal aortic aneurysms identifies cellular inflammation and appears to distinguish those patients with more rapidly progressive abdominal aortic aneurysm expansion. This technique holds major promise as a new method of risk-stratifying patients with abdominal aortic aneurysms that extends beyond the simple anatomic measure of aneurysm diameter. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794092.
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Affiliation(s)
- Jennifer M J Richards
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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43
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Mills NL, Finlayson AE, Gonzalez MC, Törnqvist H, Barath S, Vink E, Goudie C, Langrish JP, Söderberg S, Boon NA, Fox KAA, Donaldson K, Sandström T, Blomberg A, Newby DE. Diesel exhaust inhalation does not affect heart rhythm or heart rate variability. Heart 2010; 97:544-50. [PMID: 20962342 DOI: 10.1136/hrt.2010.199042] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Exposure to air pollution is associated with increases in cardiovascular morbidity and mortality. This study was undertaken to determine the effect of diesel exhaust inhalation on heart rhythm and heart rate variability in healthy volunteers and patients with coronary heart disease. DESIGN AND SETTING Double-blind randomised crossover studies in a university teaching hospital. PATIENTS 32 healthy non-smoking volunteers and 20 patients with prior myocardial infarction. INTERVENTIONS All 52 subjects were exposed for 1 h to dilute diesel exhaust (particle concentration 300 μg/m³) or filtered air. MAIN OUTCOME MEASURES Heart rhythm and heart rate variability were monitored during and for 24 h after the exposure using continuous ambulatory electrocardiography and assessed using standard time and frequency domain analysis. RESULTS No significant arrhythmias occurred during or following exposures. Patients with coronary heart disease had reduced autonomic function in comparison to healthy volunteers, with reduced standard deviations of the NN interval (SDNN, p < 0.001) and triangular index (p < 0.001). Diesel exhaust did not affect heart rate variability compared with filtered air (p > 0.05 for all) in healthy volunteers (SDNN 101 ± 6 vs 91 ± 6, triangular index 20 ± 1 vs 21 ± 1) or patients with coronary heart disease (SDNN 47 ± 5 vs 38 ± 4, triangular index 8 ± 1 vs 7 ± 1). CONCLUSIONS Brief exposure to dilute diesel exhaust does not alter heart rhythm or heart rate variability in healthy volunteers or well-treated patients with stable coronary heart disease. Autonomic dysfunction does not appear to be a dominant mechanism that can explain the observed excess in cardiovascular events following exposure to combustion-derived air pollution.
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Affiliation(s)
- Nicholas L Mills
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
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Barath S, Mills NL, Lundbäck M, Törnqvist H, Lucking AJ, Langrish JP, Söderberg S, Boman C, Westerholm R, Löndahl J, Donaldson K, Mudway IS, Sandström T, Newby DE, Blomberg A. Impaired vascular function after exposure to diesel exhaust generated at urban transient running conditions. Part Fibre Toxicol 2010; 7:19. [PMID: 20653945 PMCID: PMC2918524 DOI: 10.1186/1743-8977-7-19] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 07/23/2010] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Traffic emissions including diesel engine exhaust are associated with increased respiratory and cardiovascular morbidity and mortality. Controlled human exposure studies have demonstrated impaired vascular function after inhalation of exhaust generated by a diesel engine under idling conditions. OBJECTIVES To assess the vascular and fibrinolytic effects of exposure to diesel exhaust generated during urban-cycle running conditions that mimic ambient 'real-world' exposures. METHODS In a randomised double-blind crossover study, eighteen healthy male volunteers were exposed to diesel exhaust (approximately 250 microg/m3) or filtered air for one hour during intermittent exercise. Diesel exhaust was generated during the urban part of the standardized European Transient Cycle. Six hours post-exposure, vascular vasomotor and fibrinolytic function was assessed during venous occlusion plethysmography with intra-arterial agonist infusions. MEASUREMENTS AND MAIN RESULTS Forearm blood flow increased in a dose-dependent manner with both endothelial-dependent (acetylcholine and bradykinin) and endothelial-independent (sodium nitroprusside and verapamil) vasodilators. Diesel exhaust exposure attenuated the vasodilatation to acetylcholine (P < 0.001), bradykinin (P < 0.05), sodium nitroprusside (P < 0.05) and verapamil (P < 0.001). In addition, the net release of tissue plasminogen activator during bradykinin infusion was impaired following diesel exhaust exposure (P < 0.05). CONCLUSION Exposure to diesel exhaust generated under transient running conditions, as a relevant model of urban air pollution, impairs vasomotor function and endogenous fibrinolysis in a similar way as exposure to diesel exhaust generated at idling. This indicates that adverse vascular effects of diesel exhaust inhalation occur over different running conditions with varying exhaust composition and concentrations as well as physicochemical particle properties. Importantly, exposure to diesel exhaust under ETC conditions was also associated with a novel finding of impaired of calcium channel-dependent vasomotor function. This implies that certain cardiovascular endpoints seem to be related to general diesel exhaust properties, whereas the novel calcium flux-related effect may be associated with exhaust properties more specific for the ETC condition, for example a higher content of diesel soot particles along with their adsorbed organic compounds.
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Affiliation(s)
- Stefan Barath
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Fox KAA, Langrish JP. Risk stratification in acute coronary syndromes. Rev Esp Cardiol 2010; 63:629-632. [PMID: 20515618 DOI: 10.1016/s1885-5857(10)70135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Langrish JP, Li X, Wang S, Lee MMY, Barnes GD, Ge GL, Miller MR, Cassee FR, Boon NA, Donaldson K, Li J, Mills NL, Jiang L, Newby DE. 051 Reducing particulate air pollution exposure in patients with coronary heart disease: improved cardiovascular health. Heart 2010. [DOI: 10.1136/hrt.2010.195958.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Langrish JP, Lundbäck M, Barath S, Söderberg S, Mills NL, Newby DE, Sandström T, Blomberg A. Exposure to nitrogen dioxide is not associated with vascular dysfunction in man. Inhal Toxicol 2010; 22:192-8. [PMID: 20047363 DOI: 10.3109/08958370903144105] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Exposure to air pollution is associated with increased cardiorespiratory morbidity and mortality. It is unclear whether these effects are mediated through combustion-derived particulate matter or gaseous components, such as nitrogen dioxide. OBJECTIVES To investigate the effect of nitrogen dioxide exposure on vascular vasomotor and six fibrinolytic functions. METHODS Ten healthy male volunteers were exposed to nitrogen dioxide at 4 ppm or filtered air for 1 h during intermittent exercise in a randomized double-blind crossover study. Bilateral forearm blood flow and fibrinolytic markers were measured before and during unilateral intrabrachial infusion of bradykinin (100-1000 pmol/min), acetylcholine (5-20 microg/min), sodium nitroprusside (2-8 microg/min), and verapamil (10-100 microg/min) 4 h after the exposure. Lung function was determined before and after the exposure, and exhaled nitric oxide at baseline and 1 and 4 h after the exposure. RESULTS There were no differences in resting forearm blood flow after either exposure. There was a dose-dependent increase in forearm blood flow with all vasodilators but this was similar after either exposure for all vasodilators (p > .05 for all). Bradykinin caused a dose-dependent increase in plasma tissue-plasminogen activator, but again there was no difference between the exposures. There were no changes in lung function or exhaled nitric oxide following either exposure. CONCLUSION Inhalation of nitrogen dioxide does not impair vascular vasomotor or fibrinolytic function. Nitrogen dioxide does not appear to be a major arbiter of the adverse cardiovascular effects of air pollution.
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Affiliation(s)
- Jeremy P Langrish
- Centre for Cardiovascular Sciences, University of Edinburgh, United Kingdom
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Langrish JP, Lundbäck M, Mills NL, Johnston NR, Webb DJ, Sandström T, Blomberg A, Newby DE. Contribution of Endothelin 1 to the Vascular Effects of Diesel Exhaust Inhalation in Humans. Hypertension 2009; 54:910-5. [DOI: 10.1161/hypertensionaha.109.135947] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diesel exhaust inhalation impairs vascular function, and, although the underlying mechanism remains unclear, endothelin (ET) 1 and NO are potential mediators. The aim of this study was to identify whether diesel exhaust inhalation affects the vascular actions of ET-1 in humans. In a randomized, double-blind crossover study, 13 healthy male volunteers were exposed to either filtered air or dilute diesel exhaust (331±13 μg/m
3
). Plasma concentrations of ET-1 and big-ET-1 were determined at baseline and throughout the 24-hour study period. Bilateral forearm blood flow was measured 2 hours after the exposure during infusion of either ET-1 (5 pmol/min) or the ET
A
receptor antagonist, BQ-123 (10 nmol/min) alone and in combination with the ET
B
receptor antagonist, BQ-788 (1 nmol/min). Diesel exhaust exposure had no effect on plasma ET-1 and big-ET-1 concentrations (
P
>0.05 for both) or 24-hour mean blood pressure or heart rate (
P
>0.05 for all). ET-1 infusion increased plasma ET-1 concentrations by 58% (
P
<0.01) but caused vasoconstriction only after diesel exhaust exposure (−17% versus 2% after air;
P
<0.001). In contrast, diesel exhaust exposure reduced vasodilatation to isolated BQ-123 infusion (20% versus 59% after air;
P
<0.001) but had no effect on vasodilatation to combined BQ-123 and BQ-788 administration (
P
>0.05). Diesel exhaust inhalation increases vascular sensitivity to ET-1 and reduces vasodilatation to ET
A
receptor antagonism despite unchanged plasma ET-1 concentrations. Given the tonic interaction between the ET and NO systems, we conclude that diesel exhaust inhalation alters vascular reactivity to ET-1 probably through its effects on NO bioavailability.
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Affiliation(s)
- Jeremy P. Langrish
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
| | - Magnus Lundbäck
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
| | - Nicholas L. Mills
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
| | - Neil R. Johnston
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
| | - David J. Webb
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
| | - Thomas Sandström
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
| | - Anders Blomberg
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
| | - David E. Newby
- From the Centre for Cardiovascular Sciences (J.P.L., N.L.M., N.R.J., D.J.W., D.E.N.), University of Edinburgh, Edinburgh, United Kingdom; Department of Medicine, Division of Respiratory Medicine and Allergy, Umeå University Hospital (M.L., T.S., A.B.), Umeå, Sweden
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