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Alexandra Henneberger,^1,2 Wojciech Zareba,³ Angela Ibald-Mulli,^1,2 Regina Rückerl,² Josef Cyrys,^1,2 Jean-Phillippe Couderc,³ Betty Mykins,³ Gabriele Woelke,² H.-Erich Wichmann,^1,2 and Annette Peters^2,4

¹Ludwig-Maximilians-University of Munich, Munich, Germany; ²Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany; ³Cardiology Unit, Department of Medicine, University of Rochester, Rochester, New York, USA; ⁴Focus-Network on Aerosols and Health, GSF-National Research Center for Environment and Health, Neuherberg, Germany

Abstract
Epidemiologic studies report associations between particulate air pollution and cardiovascular morbidity and mortality, but the underlying pathophysiologic mechanisms are still unclear. We tested the hypothesis that patients with preexisting coronary heart disease experience changes in the repolarization parameters in association with rising concentrations of air pollution. A prospective panel study was conducted in Erfurt, East Germany, with 12 repeated electrocardiogram (ECG) recordings in 56 males with ischemic heart disease. Hourly particulate and gaseous air pollution and meteorologic data were acquired. The following ECG parameters reflecting myocardial substrate and vulnerability were measured: QT duration, T-wave amplitude, T-wave complexity, and variability of T-wave complexity. Fixed effect regression analysis was used adjusting for subject, trend, weekday, and meteorology. The analysis showed a significant increase in QT duration in response to exposure to organic carbon ; a significant decrease in T-wave amplitude with exposure to ultrafine, accumulation mode, and PM_2.5 particles (particles < 2.5 µm in aerodynamic diameter) ; and a corresponding significant increase of T-wave complexity in association with PM_2.5 particles for the 24 hr before ECG recordings. Variability of T-wave complexity showed a significant increase with organic and elemental carbon in the same time interval. This study provides evidence suggesting an immediate effect of air pollution on repolarization duration, morphology, and variability representing myocardial substrate and vulnerability, key factors in the mechanisms of cardiac death. Key words: air pollution, coronary disease, electrocardiography, epidemiology, repolarization. Environ Health Perspect 113:440-446 (2005) . doi:10.1289/ehp.7579 available via http://dx.doi.org/ [Online 14 January 2005]

Address correspondence to A. Henneberger, GSF-National Research Center for Environment and Health, Institute of Epidemiology, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. Telephone: 011-49-89-3187-3512. Fax: 011-49-89-3187-3380. E-mail: henneberger@gsf.de

We thank P. Severski and M. Andrews for their assistance with ECG data management and analysis.

This study was funded through the U.S. Environmental Protection Agency STAR center grant R-827354 and the Focus-Network of Aerosols and Health, GSF. The Focus-Network of Aerosols and Health coordinates and focuses all GSF research on health effects and the characterization of aerosols ; it consists of research projects of the GSF Institutes of Ecological Chemistry, Epidemiology, Inhalation Biology, Radiation Protection, and Toxicology.

The authors declare they have no competing financial interests.

Received 14 September 2004 ; accepted 13 January 2005.