Effects of reducing exposure to air pollution on submaximal cardiopulmonary test in patients with heart failure: Analysis of the randomized, double-blind and controlled FILTER-HF trial

Author(s)

Vieira, Jefferson L. ^[1] ; Guimaraes, Guilherme V. ^[1] ; de Andre, Paulo A. ^[2] ; Nascimento Saldiva, Paulo H. ^[2] ; Bocchi, Edimar A. ^[1]

Affiliation

^[1] Univ Sao Paulo, Sch Med, Heart Failure Dept, Heart Inst InCor, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Air Pollut Lab, Sao Paulo - Brazil

• Document type: Journal article
• Source: INTERNATIONAL JOURNAL OF CARDIOLOGY; v. 215, p. 92-97, JUL 15 2016.
• Web of Science Citations: 6

Abstract

Background: Air pollution exposure could mitigate the health benefits of exercise in patients with heart failure (HF). We tested the effects of a respiratory filter on HF patients exposed to air pollution during exercise. Methods and Results: Ancillary analysis of the FILTER-HF trial, focused on the exercise outcomes. In a randomized, double-blind, 3-way crossover design, 26 HF patients and 15 control volunteers were exposed to clean air, unfiltered dilute diesel engine exhaust (DE), or filtered DE for 6 min during a submaximal cardiopulmonary testing in a controlled-exposure facility. Prospectively collected data included six-minute walking test {[}6mwt], VO2, VE/VCO2 Slope, O(2)Pulse, pulmonary ventilation {[}VE], tidal volume, VD/Vt, oxyhemoglobin saturation and CO2-rebreathing. Compared to clean air, DE adversely affected VO2 (11.0 +/- 3.9 vs. 8.4 +/- 2.8 ml/kg/min; p < 0.001); 6mwt (243.3 +/- 13.0 vs. 220.8 +/- 13.7 m; p = 0.030); and O(2)Pulse (8.9 +/- 1.0 vs. 7.8 +/- 0.7 ml/beat; p < 0.001) in HF patients. Compared to DE, filtration reduced the particulate concentration from 325 +/- 31 to 25 +/- 6 mu g/m(3), and was associated with an increase in VO2 (10.4 +/- 3.8 ml/kg/min; p < 0.001 vs. DE) and O(2)Pulse (9.7 +/- 1.1 ml/beat; p < 0.001 vs. DE) in patients with HF. Filtration was associated with higher VE and CO2-rebreathing in both groups. VE/VCO2 Slope was higher among patients with HF. Conclusion: DE adversely affects exercise capacity in patients with HF. A simple respiratory filter can reduce the adverse effects of pollution on VO2 and O(2)Pulse. Given the worldwide prevalence of exposure to traffic-related air pollution, these findings are relevant for public health especially in this highly susceptible population. The filter intervention holds great promise that needs to be tested in future studies. (C) 2016 Elsevier Ireland Ltd. All rights reserved. (AU)

• FAPESP's process: 10/50150-0 - Effects of reducing particulate air pollution exposure on chemoreflex, baroreflex and endotelial function in patients with chronic heart failure: crossover, randomized double-blind trial
• Grantee: Edimar Alcides Bocchi
• Support Opportunities: Regular Research Grants