Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
JACC Heart Fail. 2016 Jan;4(1):55-64. doi: 10.1016/j.jchf.2015.07.018.
The goal of this study was to test the effects of a respiratory filter intervention (filter) during controlled pollution exposure.
Air pollution is considered a risk factor for heart failure (HF) decompensation and mortality.
This study was a double-blind, randomized to order, controlled, 3-way crossover, single-center clinical trial. It enrolled 26 patients with HF and 15 control volunteers. Participants were exposed in 3 separate sessions to clean air, unfiltered diesel exhaust exposure (DE), or filtered DE. Endpoints were endothelial function assessed by using the reactive hyperemia index (RHi), arterial stiffness, serum biomarkers, 6-min walking distance, and heart rate variability.
In patients with HF, DE was associated with a worsening in RHi from 2.17 (interquartile range [IQR]: 1.8 to 2.5) to 1.72 (IQR: 1.5 to 2.2; p = 0.002) and an increase in B-type natriuretic peptide (BNP) from 47.0 pg/ml (IQR: 17.3 to 118.0 pg/ml) to 66.5 pg/ml (IQR: 26.5 to 155.5 pg/ml; p = 0.004). Filtration reduced the particulate concentration (325 ± 31 μg/m(3) vs. 25 ± 6 μg/m(3); p < 0.001); in the group with HF, filter was associated with an improvement in RHi from 1.72 (IQR: 1.5 to 2.2) to 2.06 (IQR: 1.5 to 2.6; p = 0.019) and a decrease in BNP from 66.5 pg/ml (IQR: 26.5 to 155.5 pg/ml) to 44.0 pg/ml (IQR: 20.0 to 110.0 pg/ml; p = 0.015) compared with DE. In both groups, DE decreased the 6-min walking distance and arterial stiffness, although filter did not change these responses. DE had no effect on heart rate variability or exercise testing.
To our knowledge, this trial is the first to show that a filter can reduce both endothelial dysfunction and BNP increases in patients with HF during DE. Given these potential benefits, the widespread use of filters in patients with HF exposed to traffic-derived air pollution may have beneficial public health effects and reduce the burden of HF. (Effects of Air Pollution Exposure Reduction by Filter Mask on Heart Failure; NCT01960920).
本研究旨在测试呼吸过滤器干预（过滤器）在控制污染暴露时的效果。
空气污染被认为是心力衰竭（HF）失代偿和死亡的一个危险因素。
这是一项双盲、随机、按顺序、对照、三向交叉、单中心临床试验。共纳入 26 例 HF 患者和 15 名对照志愿者。参与者在 3 次单独的实验中分别暴露于清洁空气、未过滤的柴油废气（DE）或过滤的 DE 中。终点是通过反应性充血指数（RHi）评估内皮功能、动脉僵硬、血清生物标志物、6 分钟步行距离和心率变异性。
在 HF 患者中，DE 导致 RHi 从 2.17（四分位距[IQR]：1.82.5）恶化至 1.72（IQR：1.52.2；p=0.002），B 型利钠肽（BNP）从 47.0 pg/ml（IQR：17.3118.0 pg/ml）增加至 66.5 pg/ml（IQR：26.5155.5 pg/ml；p=0.004）。过滤降低了颗粒物浓度（325±31 μg/m³ vs. 25±6 μg/m³；p<0.001）；在 HF 组中，过滤器使 RHi 从 1.72（IQR：1.52.2）改善至 2.06（IQR：1.52.6；p=0.019），BNP 从 66.5 pg/ml（IQR：26.5155.5 pg/ml）降至 44.0 pg/ml（IQR：20.0110.0 pg/ml；p=0.015），与 DE 相比。在两组中，DE 降低了 6 分钟步行距离和动脉僵硬，尽管过滤器没有改变这些反应。DE 对心率变异性或运动试验没有影响。
据我们所知，这项试验首次表明，在 DE 期间，过滤器可降低 HF 患者的内皮功能障碍和 BNP 升高。鉴于这些潜在的益处，在接触交通衍生空气污染的 HF 患者中广泛使用过滤器可能具有有益的公共卫生效果，并减轻 HF 的负担。[空气污染物暴露减少对心力衰竭的影响；NCT01960920]
