Rapid Fire Session

Session: Rapid Fire Session 5: Standardization, Multicenter Clinical Trials (Monitor 2)

Association between Fine Particulate Air Pollution Exposure and Subclinical Myocardial Fibrosis in Structurally Normal Hearts: a CMR-based study.

Saturday, February 7, 2026

10:36 AM - 10:43 AM

Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

Presenting Author(s)

Stefano Figliozzi, MD

Cardiologist
Humanitas Research Institute
Alatri, Lazio, Italy

Primary Author(s)

Stefano Figliozzi, MD

Cardiologist
Humanitas Research Institute
Alatri, Lazio, Italy

Co-Author(s)

GF

Gaia Filiberti, MD

Cardiology Resident
IRCCS Humanitas Research Hospital, Italy
DD

Dario Donia, MD

Cardiology Resident
IRCCS Humanitas Research Hospital, Italy
Lc

Lorenzo cambini

Student
Humanitas University, Italy
EL

Elena Locatelli, MD

Radiology resident
IRCCS Humanitas Research Hospital, Italy
SD

Silvana Di Maio, MD

Cardiologist
IRCCS Humanitas Research Hospital, Italy
CL

Costanza Lisi, MD

Radiology Resident
Humanitas Research Institute, Italy
FC

Federica Catapano, MD

Consultant Radiologist
Humanitas Research Institute, Italy
MF

Marco Francone, MD, PhD

Radiology Full Professorr
S. Andrea Hospital, Sapienza University of Rome
Rome, Lazio, Italy
GS

Giulio Giuseppe Stefanini, MD, PhD

Cardiologist
IRCCS Humanitas Research Hospital, Italy
RB

Renato M Bragato, MD

Consultant Cardiologist
Humanitas Research Institute, Italy
AL

Andrea Laghi, MD, PhD

Radiologist
IRCCS Humanitas Research Hospital, Italy
GG

Georgios Georgiopoulos, MD, PhD, MSc

Consultant Cardiologist
University of Athens, Greece
GC

Gianluigi Condorelli, MD, PhD

Professor of Cardiology
Humanitas Research Institute, Italy

Background: Air pollution is a major global health concern, but its impact on early myocardial remodeling in individuals without overt cardiovascular disease remains incompletely understood. Cardiac magnetic resonance (CMR) mapping provides sensitive markers of diffuse myocardial fibrosis and inflammation that may reveal subclinical injury.

Methods: We retrospectively studied 231 consecutive patients (mean age 45 ± 21 years, 53% males) undergoing clinically indicated CMR between May 2020 and November 2024 at a tertiary center. All had structurally normal hearts, preserved function, and no late gadolinium enhancement. Individual long-term exposure to fine (PM2.5) and coarse (PM10) particulate matter was derived from the nearest European Environment Agency monitoring stations. CMR parameters included left ventricular end-diastolic volume indexed (LVEDVi), left ventricular ejection fraction (LVEF), native T1, and T2 mapping. Associations with pollutant exposure were tested with multivariable linear and logistic regression adjusted for demographic, clinical, and socioeconomic factors.

Results: After adjustment, higher PM2.5 exposure was independently associated with higher native T1 values (β = 0.285 ms per 1 µg/m³; 95%CI 0.05–0.52; p = 0.020), whereas no associations were found with T2, LVEDVi, LVEF, or with PM10 exposure. Restricted cubic spline models confirmed a linear dose–response relationship for PM2.5 and T1. Patients with High PM2.5 exposure had significantly higher T1 compared with those with Low exposure (1007.2 ± 23.8 vs. 987.8 ± 27.0 ms; p = 0.020). In multivariable logistic regression, PM2.5 was associated with pathological T1 (OR 1.03 per µg/m³; 95%CI 1.00–1.06; p = 0.020), with male sex and diabetes being other independent predictors.

Conclusion: In individuals with structurally normal hearts, chronic PM2.5 exposure was independently associated with higher native T1 values and pathological T1, suggesting early diffuse myocardial fibrosis. Air pollution may act as a cofactor in myocardial remodeling preceding heart failure, warranting confirmation in larger prospective studies.

Baseline patients characteristics and CMR parameters of the study population.

Categorial variables are expressed as count (proportions), continuous variable as means (SD) or medians (IQR), as appropriate.

Legend – BSA- Body Surface Area, CMR – Cardiac Magnetic Resonance, IHD- Ischemic Heart Disease, LA- Left Atrium, LAi- Left Atrium index., RA- Right Atrium, RAi- Right Atrium index., LVEDV- Left Ventricular End-Diastolic Volume, LVEDVi- Left Ventricular End-Diastolic Volume index., LVESV- Left Ventricular End-Systolic Volume, LVEF- Left Ventricular Ejection Fraction, LVM- Left Ventricular Mass, LVMi- Left Ventricular Mass index, RVEDV – Right Ventricular End-Diastolic Volume, RVEDVi – Right Ventricular End-Diastolic Volume index, RVEF – Right Ventricular Ejection Fraction, RVESV – Right Ventricular End-Systolic Volume.

Baseline characteristics	Total cohort (n=231)
Age (years)	45.1± 21.3
Males (%)	122 (53%)
BSA (cm²)	1.82 ± 0.23
Family history of IHD (%)	30 (13%)
Hypertension (%)	57 (24.7%)
Diabetes (%)	4 (1.7%)
Smoking history (%)	19 (8.2%)
Dyslipidemia (%)	59 (25.5%)
Occupational status (%) Unemployed Employed Student Retired	23 (10%) 73 (31.6%) 17 (7.4%) 19 (8.2%)
Education (%) Compulsory education Academic degree	69 (29.9%) 63 (27.3%)
PM2.5 (µg/m³)	28.57 ± 14.75
PM10 (µg/m³)	56.03 ± 35.28
CMR findings	Total cohort (n=231)
T1 (msec)	993.87 ± 27.41
T2 (msec)	46.68 ± 4.16
LA area (cm²)	19.04 ± 3.80
LAi area (cm²/m²)	10.52 ± 2.08
RA area (cm²)	18.00 ± 4.05
RAi area (cm²/m²)	9.92 ± 2.14
LVEDV (mL)	139.27 ± 30.88
LVEDVi (mL/m²)	76.39 ± 14.15
LVESV (mL)	54.00 ± 14.86
LVM (g)	85.83 ± 23.14
LVMi (g/m²)	46.74 ± 9.79
LVEF (%)	61.49 ± 4.8
RVEDV (mL)	144.26 ± 35.42
RVEDVi ( mL/m²)	79.06 ± 16.45
RVESV (mL)	61.63 ± 19.22
RVEF (%)	57.73 ± 5.52

Baseline patients characteristics and CMR parameters of the study population.

CMR parameters of the study population.

Baseline characteristics	Total cohort (n=231)
Age (years)	45.1± 21.3
Males (%)	122 (53%)
BSA (cm²)	1.82 ± 0.23
Family history of IHD (%)	30 (13%)
Hypertension (%)	57 (24.7%)
Diabetes (%)	4 (1.7%)
Smoking history (%)	19 (8.2%)
Dyslipidemia (%)	59 (25.5%)
Occupational status (%) Unemployed Employed Student Retired	23 (10%) 73 (31.6%) 17 (7.4%) 19 (8.2%)
Education (%) Compulsory education Academic degree	69 (29.9%) 63 (27.3%)
PM2.5 (µg/m³)	28.57 ± 14.75
PM10 (µg/m³)	56.03 ± 35.28
CMR findings	Total cohort (n=231)
T1 (msec)	993.87 ± 27.41
T2 (msec)	46.68 ± 4.16
LA area (cm²)	19.04 ± 3.80
LAi area (cm²/m²)	10.52 ± 2.08
RA area (cm²)	18.00 ± 4.05
RAi area (cm²/m²)	9.92 ± 2.14
LVEDV (mL)	139.27 ± 30.88
LVEDVi (mL/m²)	76.39 ± 14.15
LVESV (mL)	54.00 ± 14.86
LVM (g)	85.83 ± 23.14
LVMi (g/m²)	46.74 ± 9.79
LVEF (%)	61.49 ± 4.8
RVEDV (mL)	144.26 ± 35.42
RVEDVi ( mL/m²)	79.06 ± 16.45
RVESV (mL)	61.63 ± 19.22
RVEF (%)	57.73 ± 5.52

Categorial variables are expressed as count (proportions), continuous variable as means (SD) or medians (IQR), as appropriate.