Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke
Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke
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DOI：
10.1093/eurheartj/ehs250
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发表时间：
2012-11-01
影响因子：
39.3
通讯作者：
Diener, Hans-Christoph
中科院分区：
文献类型：
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作者：
Boehm, Michael;Cotton, Daniel;Diener, Hans-Christoph
复发性卒中是一种常见的致残性事件。高心率与心血管结局相关。我们在PRoFESS研究的高危人群中调查了静息心率对复发性卒中后心血管和神经系统结局的影响。（平均年龄66.1岁，SD 8.6岁）将分配至PRoFESS试验治疗组的受试者按基线心率的五分位数进行汇总，并根据心血管和功能卒中后结局：复发性卒中和主要心血管结局，如卒中、心肌梗死、心力衰竭恶化或新发心力衰竭以及心血管和非心血管原因导致的死亡。预定义终点为复发性卒中后的残疾（3个月时采用改良兰金量表（mRS）和Barthel指数进行评估）和认知功能（随机化后4周和倒数第二次访视时采用简易精神状态检查（MMSE）评分进行评估）。心率最高的两个五分位数（7782和82 b.p.m.）与最低五分位数相比，总死亡风险较高[风险比（HR）1.42，95 CI 1.191.69和HR 1.74，95 CI 1.482.06，P 0.0001]。对于血管性死亡[7176 b.p.m.，HR 1.39（1.111.74），P 0.0001]和非血管性死亡[从82 b.p.m.，HR 1.66（1.292.13），P 0.0016]。心肌梗死（P 0.7084）和复发性卒中（P 0.1379）与基线心率无显著相关性。风险比根据包括基线血压在内的多种混杂因素进行调整。在复发性卒中患者组中，使用Barthel指数测量所有心率组中较低心率与较好结局的相关性。此外，根据1个月和倒数第二次访视时的MMSE评分24分或这两个时间段之间的评分下降0.02分，基线心率与发生显著认知下降显著相关。观察到低心率时独立性评分更好。心率是卒中患者死亡率的风险指标，重要的是，低心率与缺血性卒中后更好的功能结局和更少的认知下降相关。试验注册：ClinicalTrials.gov，编号NTC00153062。
Recurrent stroke is a frequent and disabling event. A high heart rate is associated with cardiovascular outcomes. We investigated the effects of the resting heart rate on cardiovascular and neurological outcomes after recurrent stroke in the high-risk population of the PRoFESS study.A total of 20 165 patients after ischaemic stroke (mean age 66.1, SD 8.6 years) assigned to the treatment arms of the PRoFESS trial were pooled divided by quintiles of the baseline heart rate and analysed according to cardiovascular and functional outcomes after stroke: recurrent stroke and major cardiovascular outcomes such as stroke, myocardial infarction, and worsening or new-onset heart failure as well as death from cardiovascular and non-cardiovascular causes. Pre-defined endpoints were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and the Barthel index at 3 months, and cognitive function, assessed with the Mini-Mental State Examination (MMSE) score at 4 weeks after randomization and at the penultimate visit. Patients in the two highest quintiles of heart rate (7782 and 82 b.p.m.) were at a higher risk for total death [hazard ratio (HR) 1.42, 95 CI 1.191.69 and HR 1.74, 95 CI 1.482.06, P 0.0001] compared with the lowest quintile. Similar results were observed for vascular death [7176 b.p.m., HR 1.39 (1.111.74), P 0.0001] and non-vascular death [from 82 b.p.m., HR 1.66 (1.292.13), P 0.0016]. Myocardial infarction (P 0.7084) and recurrent stroke (P 0.1379) were not significantly associated with the baseline heart rate. Hazard ratios were adjusted to multiple confounders including the baseline blood pressure. In the group of patients with a recurrent stroke, an association of a lower heart rate to better outcomes was measured with the Barthel index across all heart rate groups. In addition, there was a significant association of the baseline heart rate to the occurrence of significant cognitive decline according to an MMSE score 24 points at 1 month and at the penultimate visit or a decline of epsilon 2 points between these two time periods. Better independence score at a low heart rate were observed.The heart rate is a risk indicator for mortality in patients with stroke and, importantly, a low heart rate is associated with a better functional outcome and less cognitive decline after an ischaemic stroke.Trial registration: ClinicalTrials.gov, number NTC00153062.