Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China.
Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Atherosclerosis. 2017 Aug;263:1-6. doi: 10.1016/j.atherosclerosis.2017.05.020. Epub 2017 May 19.
The association between heart rate and prognosis of ischemic stroke remains debatable, and whether renal function status influences the relationship between them is still not elucidated.
A total of 3923 ischemic stroke patients were included in this prospective multicenter study from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after stroke. Secondary outcomes were, separately, death and major disability.
The association between heart rate tertiles and primary outcome was appreciably modified by renal function status (p = 0.037). After multivariate adjustment, high heart rate was associated with increased risk of primary outcome in patients with abnormal renal function (odds ratio, 1.61; 95% confidence interval, 1.02-2.54; p = 0.039) but not in patients with normal renal function (odds ratio, 0.96; 95% confidence interval, 0.75-1.23; p = 0.741), when two extreme tertiles were compared. Each 10 bpm increase of heart rate was associated with 21% (95% CI: 1%-44%) increased risk of primary outcome, and a linear association between heart rate and risk of primary outcome was observed among patients with abnormal renal function (p for linearity = 0.002).
High heart rate may be merely a strong predictor of poor prognosis in acute ischemic stroke patients with abnormal renal function, suggesting that heart rate reduction should be applied to ischemic stroke patients with abnormal renal function to improve their prognosis.
心率与缺血性脑卒中预后之间的关系仍存在争议，肾功能状态是否影响两者之间的关系尚不清楚。
本前瞻性多中心研究共纳入 3923 例缺血性脑卒中患者，来自中国急性缺血性脑卒中降压试验（CATIS）。主要结局为脑卒中后 3 个月时死亡和主要残疾（改良 Rankin 量表评分≥3）的联合结局。次要结局分别为死亡和主要残疾。
心率三分位与主要结局之间的关联受到肾功能状态的显著影响（p=0.037）。在多变量调整后，在肾功能异常的患者中，高心率与主要结局风险增加相关（比值比，1.61；95%置信区间，1.02-2.54；p=0.039），但在肾功能正常的患者中则不然（比值比，0.96；95%置信区间，0.75-1.23；p=0.741），当比较两个极端三分位时。心率每增加 10 bpm，主要结局的风险增加 21%（95%可信区间：1%-44%），且在肾功能异常的患者中，心率与主要结局风险之间存在线性关系（p 线性=0.002）。
高心率可能仅是肾功能异常的急性缺血性脑卒中患者预后不良的一个强烈预测指标，这提示应降低心率以改善肾功能异常的缺血性脑卒中患者的预后。
