Ruben Juarez-Prera

Estudio comparativo de las partículas en aire ambiente en pacientes ingresados por insuficiencia cardiaca y síndrome coronario agudo

INTRODUCTION AND OBJECTIVES Currently air pollution is considered as an emerging risk factor for cardiovascular disease. Our objective was to study the concentrations of particulate matter in ambient air and analyze their relationship with cardiovascular risk factors in patients admitted to a cardiology department of a tertiary hospital with the diagnosis of heart failure or acute coronary syndrome (ACS). METHODS We analyzed 3950 consecutive patients admitted with the diagnosis of heart failure or ACS. We determined the average concentrations of different sizes of particulate matter (<10, <2.5, and <1 μm and ultrafine particles) from 1 day or up to 7 days prior to admission (1 to 7 days lag time). RESULTS There were no statistically significant differences in mean concentrations of particulate matter <10, <2.5 and <1 μm in size in both populations. When comparing the concentrations of ultrafine particles of patients admitted due to heart failure and acute coronary syndrome, it was observed that the former had a tendency to have higher values (19 845.35 ± 8 806.49 vs 16 854.97 ± 8005.54 cm⁻³, P <.001). The multivariate analysis showed that ultrafine particles are a risk factor for admission for heart failure, after controlling for other cardiovascular risk factors (odds ratio=1.4; confidence interval 95%, from 1.15 to 1.66 P=.02). CONCLUSIONS In our study population, compared with patients with ACS, exposure to ultrafine particles is a precipitating factor for admission for heart failure.

Relación entre exposición a corto plazo a dióxido de azufre atmosférico y lesiones obstructivas en el síndrome coronario agudo

BACKGROUND AND OBJECTIVES Urban air pollutants are composed of a heterogeneous mixture of substances in gas and aerosol states. The aim of this study was to compare the effects caused by exposure to contaminants in the gas phase and atmospheric particles in ambient air in patients hospitalized for acute coronary syndrome (ACS) regarding the presence or absence of significant obstructive lesions (SOL) in epicardial coronary arteries. PATIENTS AND METHODS Prospectively analyzed a total of 2,110 patients with a diagnosis of ACS. We determined the mean concentrations of contaminants in the gas phase and atmospheric particles from the day before until 7 days prior to admission (1 to 7 days lag time). We divided the study population into those with presence or absence of SOL. RESULTS Of the 2,110 patients with ACS, 1,892 presented SOL and 218 without SOL. When comparing the concentrations of contaminants in the gas phase, we observed that the sulfur dioxide in patients with SOL had a trend toward higher values (10.93 ± 8.33 versus 9.31 ± 6.77 μg/m(3); P = .004). Multivariate analysis shows that for every 10 μg/m(3) increase of sulfur dioxide, there is an increase in the risk of hospitalization for ACS with SOL a 41% (odds ratio 1.41; 95% confidence interval 1.039-1.931; P = .028). CONCLUSIONS In our study population, exposure to high concentrations of sulfur dioxide is a precipitating factor for admission of patients with ACS and SOL.

Short-term effects of air pollution, markers of endothelial activation, and coagulation to predict major adverse cardiovascular events in patients with acute coronary syndrome: insights from AIRACOS study.

Abstract The aim of this study was to determine whether markers of inflammation and coagulation are associated with short-term particulate matter exposure and predict major adverse cardiovascular events at 360 d in patients with acute coronary syndrome (ACS). We included 307 consecutive patients, and assessed the average concentrations of data on atmospheric pollution in ambient air and meteorological variables from 1 d up to 7 d prior to admission. In patients with ACS, the markers of endothelial activation and coagulation, but not black carbon exposure, are associated with major adverse cardiovascular events at one-year follow-up.

Air pollution and heart failure: Relationship with the ejection fraction.

AIM To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m(3) vs 4.50 ± 2.34 μg/m(3), P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.

Usefulness of serum neopterin levels in acute decompensated heart failure to predict renal dysfunction.

Context: Neopterin serum concentration increases in the presence of renal dysfunction. Objective: We sought to determine the relationship between admission serum neopterin levels and worsening renal function (WRF) in patients with heart failure (HF). Methods: We prospectively measured serum neopterin levels in patients with HF and the patients were subdivided into two groups: with and without WRF during hospital admission. Results: Logistic regression analysis showed that high serum neopterin levels at admission were associated with a greater likelihood of developing WRF. Conclusions: Patients admitted to hospital with HF, elevated serum neopterin levels are associated with an increased risk of developing WRF.

Influencia de las condiciones meteorológicas en el ingreso hospitalario en pacientes con síndrome coronario agudo con y sin elevación del segmento ST: resultados del estudio AIRACOS

OBJECTIVE Evaluate whether the meterological parameters affecting revenues in patients with ST-segment and non-ST-segment elevation ACS. DESIGN A prospective cohort study was carried out. SETTING Coronary Care Unit of Hospital Universitario de Canarias PATIENTS We studies a total of 307 consecutive patients with a diagnosis of ST-segment and non-ST-segment elevation ACS. We analyze the average concentrations of particulate smaller than 10 and 2.5μm diameter, particulate black carbon, the concentrations of gaseous pollutants and meteorological parameters (wind speed, temperature, relative humidity and atmospheric pressure) that were exposed patients from one day up to 7 days prior to admission. INTERVENTIONS None. VARIABLES OF INTEREST Demographic, clinical, atmospheric particles, concentrations of gaseous pollutants and meterological parameters. RESULTS A total of 138 (45%) patients were classified as ST-segment and 169 (55%) as non-ST-segment elevation ACS. No statistically significant differences in exposure to atmospheric particles in both groups. Regarding meteorological data, we did not find statistically significant differences, except for higher atmospheric pressure in ST-segment elevation ACS (999.6±2.6 vs. 998.8±2.5 mbar, P=.008). Multivariate analysis showed that atmospheric pressure was significant predictor of ST-segment elevation ACS presentation (OR: 1.14, 95% CI: 1.04-1.24, P=.004). CONCLUSIONS In the patients who suffer ACS, the presence of higher number of atmospheric pressure during the week before the event increase the risk that the ST-segment elevation ACS.