Nakanishi Koki, Di Tullio Marco R, Qian Min, Thompson John L P, Labovitz Arthur J, Mann Douglas L, Sacco Ralph L, Pullicino Patrick M, Freudenberger Ronald S, Teerlink John R, Graham Susan, Lip Gregory Y H, Levin Bruce, Mohr Jay P, Buchsbaum Richard, Estol Conrado J, Lok Dirk J, Ponikowski Piotr, Anker Stefan D, Homma Shunichi
Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
Cerebrovasc Dis. 2017;44(1-2):43-50. doi: 10.1159/000474958. Epub 2017 Apr 19.
Although high resting heart rate (RHR) is known to be associated with an increased risk of mortality and hospital admission in patients with heart failure, the relationship between RHR and ischemic stroke remains unclear. This study is aimed at investigating the relationship between RHR and ischemic stroke in patients with heart failure in sinus rhythm.
We examined 2,060 patients with systolic heart failure in sinus rhythm from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. RHR was determined from baseline electrocardiogram, and was examined as both a continuous variable and a categorical variable using quartiles. Ischemic strokes were identified during follow-up and adjudicated by physician review.
During 3.5 ± 1.8 years of follow-up, 77 patients (5.3% from Kaplan-Meier [KM] curve) experienced an ischemic stroke. The highest incidence of ischemic stroke (21/503 [KM 6.9%]) was observed in the lowest RHR quartile (RHR <64 beats/min) compared to other groups; 22/573 (KM 5.3%) in 64-70 beats/min, 13/465 (KM 3.5%) in 71-79 beats/min, and 21/519 (KM 5.4%) in RHR >79 beats/min (p = 0.693). Multivariable Cox proportional hazards analysis revealed that RHR was significantly associated with ischemic stroke (hazard ratio per unit decrease: 1.07, 95% CI 1.02-1.13, when RHR <64/beats/min; p = 0.038), along with a history of stroke or transient ischemic attack and left ventricular ejection fraction.
In contrast to its beneficial effect on mortality and hospital re-admissions, lower RHR may increase the risk of ischemic stroke in patients with systolic heart failure in sinus rhythm.
尽管已知静息心率（RHR）高与心力衰竭患者的死亡风险和住院风险增加相关，但RHR与缺血性卒中之间的关系仍不明确。本研究旨在调查窦性心律心力衰竭患者中RHR与缺血性卒中之间的关系。
我们在“射血分数降低的心力衰竭患者中使用华法林与阿司匹林对比”试验中检查了2060例窦性心律的收缩性心力衰竭患者。RHR由基线心电图确定，并作为连续变量和使用四分位数的分类变量进行检查。在随访期间识别缺血性卒中，并由医生复查判定。
在3.5±1.8年的随访期间，77例患者（来自Kaplan-Meier [KM]曲线的5.3%）发生了缺血性卒中。与其他组相比，在最低RHR四分位数（RHR<64次/分钟）中观察到缺血性卒中的发生率最高（21/503 [KM 6.9%]）；64-70次/分钟组为22/573（KM 5.3%），71-79次/分钟组为13/465（KM 3.5%），RHR>79次/分钟组为21/519（KM 5.4%）（p = 0.693）。多变量Cox比例风险分析显示，RHR与缺血性卒中显著相关（每单位降低的风险比：1.07，95%CI 1.02-1.13，当RHR<64/次/分钟时；p = 0.038），同时与卒中或短暂性脑缺血发作史以及左心室射血分数有关。
与对死亡率和再次住院的有益作用相反，较低的RHR可能会增加窦性心律收缩性心力衰竭患者发生缺血性卒中的风险。
