{"title":"静息心率高与中风患者的心血管死亡有关,与性别无关。","authors":"Christine Heuer,Catherine Gebhard,Ashfaq Shuaib,Ulrike Held,Susanne Wegener,","doi":"10.1159/000541317","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nHigh resting heart rate (HRHR) is a surrogate marker of increased sympathetic outflow. In acute stroke patients, HRHR is more commonly observed in women than in men. We analysed whether HRHR (>86 bpm) adds incremental prognostic value for stroke outcomes in women.\r\n\r\nMETHODS\r\nWe analysed data of 6024 patients (2568 women, mean age 68.98 years) with acute ischemic stroke from the Virtual International Stroke Trials Archive (VISTA).\r\n\r\nRESULTS\r\nPatients with HRHR were more often female (45.3 vs 41.8%, p = 0.017), younger (66.0±13.2 vs. 67.8±12.6 years, p<0.001), had higher baseline systolic blood pressure and more often diabetes. The primary composite endpoint of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or cardiovascular death within 90 days occurred more often in patients with HRHR (19.3 vs. 14.6%, p <0.001). HRHR was associated with worse functional outcome at 90 days as assessed by modified Rankin Scale (mRS90: 3.03±1.98 vs. 2.82±1.94, p = 0.001). As exclusion of deceased patients (mRS90 of 6) resulted in a loss of association of HRHR with mRS90, it can be assumed that HRHR is mainly associated with post-stroke vascular mortality, but not disability. Female sex was not associated with the primary endpoint but with adverse functional outcome measured by mRS90.\r\n\r\nCONCLUSION\r\nHRHR was associated with adverse events and mortality after stroke. Despite a higher prevalence of HRHR in women, they did not reach the primary endpoint more often. However, women had a worse functional outcome (mRS) three months after stroke, independent of HRHR.","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"High resting heart rate is associated with cardiovascular death in patients with stroke, independent of sex.\",\"authors\":\"Christine Heuer,Catherine Gebhard,Ashfaq Shuaib,Ulrike Held,Susanne Wegener,\",\"doi\":\"10.1159/000541317\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\r\\nHigh resting heart rate (HRHR) is a surrogate marker of increased sympathetic outflow. In acute stroke patients, HRHR is more commonly observed in women than in men. We analysed whether HRHR (>86 bpm) adds incremental prognostic value for stroke outcomes in women.\\r\\n\\r\\nMETHODS\\r\\nWe analysed data of 6024 patients (2568 women, mean age 68.98 years) with acute ischemic stroke from the Virtual International Stroke Trials Archive (VISTA).\\r\\n\\r\\nRESULTS\\r\\nPatients with HRHR were more often female (45.3 vs 41.8%, p = 0.017), younger (66.0±13.2 vs. 67.8±12.6 years, p<0.001), had higher baseline systolic blood pressure and more often diabetes. The primary composite endpoint of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or cardiovascular death within 90 days occurred more often in patients with HRHR (19.3 vs. 14.6%, p <0.001). HRHR was associated with worse functional outcome at 90 days as assessed by modified Rankin Scale (mRS90: 3.03±1.98 vs. 2.82±1.94, p = 0.001). As exclusion of deceased patients (mRS90 of 6) resulted in a loss of association of HRHR with mRS90, it can be assumed that HRHR is mainly associated with post-stroke vascular mortality, but not disability. Female sex was not associated with the primary endpoint but with adverse functional outcome measured by mRS90.\\r\\n\\r\\nCONCLUSION\\r\\nHRHR was associated with adverse events and mortality after stroke. Despite a higher prevalence of HRHR in women, they did not reach the primary endpoint more often. However, women had a worse functional outcome (mRS) three months after stroke, independent of HRHR.\",\"PeriodicalId\":9683,\"journal\":{\"name\":\"Cerebrovascular Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cerebrovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000541317\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000541317","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景高静息心率(HRHR)是交感神经外流增加的替代标志。在急性中风患者中,女性比男性更常观察到 HRHR。方法我们分析了虚拟国际卒中试验档案(VISTA)中 6024 名急性缺血性卒中患者(2568 名女性,平均年龄 68.98 岁)的数据。结果HRHR患者多为女性(45.3% vs. 41.8%,p = 0.017)、年轻(66.0±13.2 岁 vs. 67.8±12.6岁,p<0.001)、基线收缩压较高且多患有糖尿病。90天内复发缺血性卒中、短暂性脑缺血发作、心肌梗死或心血管死亡的主要复合终点在HRHR患者中发生率更高(19.3% vs. 14.6%,p<0.001)。根据改良兰金量表(mRS90:3.03±1.98 vs. 2.82±1.94,p = 0.001)评估,HRHR 与 90 天内功能预后较差有关。由于排除了死亡患者(mRS90 为 6),HRHR 与 mRS90 失去了联系,因此可以认为 HRHR 主要与卒中后血管死亡率有关,而与残疾无关。结论 HRHR 与脑卒中后的不良事件和死亡率有关。尽管女性 HRHR 患病率较高,但她们并没有更频繁地达到主要终点。然而,女性在卒中后三个月的功能预后(mRS)较差,这与 HRHR 无关。
High resting heart rate is associated with cardiovascular death in patients with stroke, independent of sex.
BACKGROUND
High resting heart rate (HRHR) is a surrogate marker of increased sympathetic outflow. In acute stroke patients, HRHR is more commonly observed in women than in men. We analysed whether HRHR (>86 bpm) adds incremental prognostic value for stroke outcomes in women.
METHODS
We analysed data of 6024 patients (2568 women, mean age 68.98 years) with acute ischemic stroke from the Virtual International Stroke Trials Archive (VISTA).
RESULTS
Patients with HRHR were more often female (45.3 vs 41.8%, p = 0.017), younger (66.0±13.2 vs. 67.8±12.6 years, p<0.001), had higher baseline systolic blood pressure and more often diabetes. The primary composite endpoint of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or cardiovascular death within 90 days occurred more often in patients with HRHR (19.3 vs. 14.6%, p <0.001). HRHR was associated with worse functional outcome at 90 days as assessed by modified Rankin Scale (mRS90: 3.03±1.98 vs. 2.82±1.94, p = 0.001). As exclusion of deceased patients (mRS90 of 6) resulted in a loss of association of HRHR with mRS90, it can be assumed that HRHR is mainly associated with post-stroke vascular mortality, but not disability. Female sex was not associated with the primary endpoint but with adverse functional outcome measured by mRS90.
CONCLUSION
HRHR was associated with adverse events and mortality after stroke. Despite a higher prevalence of HRHR in women, they did not reach the primary endpoint more often. However, women had a worse functional outcome (mRS) three months after stroke, independent of HRHR.
期刊介绍:
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.