School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Environ Int. 2023 Aug;178:108130. doi: 10.1016/j.envint.2023.108130. Epub 2023 Aug 2.
Electrocardiogram (ECG) abnormalities are known to have prognostic value for heart conditions, while evidence on the relationship between long-term exposure to PM constituents and electrocardiographic (ECG) abnormalities is limited. This study aimed to quantify the association between long-term exposure to PM constituents and changes in ECG diagnoses.
We designed a longitudinal study among participants with repeated records of ECG examination based on the China National Stroke Screening Survey 2013-2018. Logistic regressions with multiple adjustment, estimated by the generalized estimating equation to incorporate repeated measurements, were used to assess the associations between the occurrence of any physician-diagnosed ECG abnormalities and long-term exposure to PM constituents.
We included 61,094 participants with 132,249 visits. All five constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) were significantly associated with an increased risk of ECG abnormalities. The excess risk of ECG abnormalities per interquartile-range increase in exposure was the highest for sulfate (26%, 95% confidence interval [CI] 23-29%), followed by ammonium (22%, 19-26%), nitrate (21%, 17-24%), black carbon (16%, 13-10%) and organic matter (9%,6%-11%). We also found that atrial fibrillation patients might be susceptible to the adverse effects of PM constituents on ECG.
Differential associations between various constituents of PM and ECG abnormalities were found. The unequal toxicities for different chemical constituents of ambient particles on cardiovascular electrophysiological endpoints should be taken into consideration when considering the biological pathways linking PM and cardiovascular conditions.
心电图（ECG）异常已知对心脏状况具有预后价值，而关于 PM 成分的长期暴露与心电图（ECG）异常之间的关系的证据有限。本研究旨在量化长期暴露于 PM 成分与心电图诊断变化之间的关联。
我们基于中国国家卒中筛查调查 2013-2018 年，在重复记录心电图检查的参与者中设计了一项纵向研究。使用广义估计方程进行多因素调整的逻辑回归，以纳入重复测量，评估任何医生诊断的心电图异常的发生与 PM 成分的长期暴露之间的关联。
我们纳入了 61094 名参与者，共进行了 132249 次访问。所有五种成分（硫酸盐、硝酸盐、铵、有机物和黑碳）均与心电图异常的风险增加显著相关。暴露于四分位距增加时，心电图异常的额外风险以硫酸盐最高（26%，95%置信区间[CI]23-29%），其次是铵（22%，19-26%）、硝酸盐（21%，17-24%）、黑碳（16%，13-10%）和有机物（9%，6%-11%）。我们还发现心房颤动患者可能容易受到 PM 成分对心电图的不利影响。
发现 PM 不同成分与心电图异常之间存在差异关联。在考虑 PM 与心血管状况之间的联系的生物学途径时，应考虑环境颗粒中不同化学成分的不等毒性对心血管电生理终点的影响。
