Background and Purpose- There is a paucity of information about the role of resting heart rate in the prediction of outcome events in patients with ischemic stroke with atrial fibrillation. We aimed to investigate the relationships between the level and variability of heart rate in the acute stroke period and stroke recurrence and mortality after acute ischemic stroke in patients with atrial fibrillation. Methods- Acute patients with ischemic stroke who had atrial fibrillation and were hospitalized within 48 hours of stroke onset were identified from a multicenter prospective stroke registry database. The acute stroke period was divided into early (within 24 hours of hospitalization) and late (72 hours to 7 days from onset) stages, and data on heart rate in both stages were collected. Moreover, the level and variability of heart rate were assessed using mean values and coefficients of variation. Outcome events were prospectively monitored up to 1 year after the index stroke. Results- Among 2046 patients eligible for the early acute stage analysis, 102 (5.0%) had a stroke recurrence, and 440 (21.5%) died during the first year after stroke. A statistically significant nonlinear J-shaped association was observed between mean heart rate and mortality (P<0.04 for quadratic and overall effect) but not between mean heart rate and stroke recurrence (P>0.1 for quadratic and overall effect). The nonlinear and overall effects of the coefficients of variation of heart rate were not significant for all outcome variables. The same results were observed in the late acute stage analysis (n=1576). Conclusions- In patients with atrial fibrillation hospitalized for acute ischemic stroke, the mean heart rate during the acute stroke period was not associated with stroke recurrence but was associated with mortality (nonlinear, J-shaped association). The relationships between heart rate and outcomes were not observed with respect to heart rate variability.

中文翻译：

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心率对房颤急性缺血性卒中中风复发和死亡率的影响。

背景与目的：尚缺乏关于静息心率在缺血性卒中伴房颤患者预后事件预测中的作用的信息。我们旨在研究心房颤动患者急性卒中期间心率水平和变异性与急性缺血性卒中后卒中复发和死亡率之间的关系。方法-从多中心前瞻性卒中注册数据库中识别出患有房颤并在卒中发作后48小时内住院的急性缺血性卒中患者。将急性中风期分为早期（住院24小时内）和晚期（发病后72小时至7天）阶段，并收集了两个阶段的心率数据。而且，使用平均值和变异系数评估心率的水平和变异性。前瞻性监测指标卒中后1年的结果事件。结果-在2046例符合早期急性期分析要求的患者中，有102例（5.0％）发生了中风复发，而440例（21.5％）在中风后的第一年死亡。在平均心率和死亡率之间观察到统计学上显着的非线性J形关联（对于二次和总体影响，P <0.04），但在平均心率和中风复发之间（对于二次和总体影响，P> 0.1）则没有。对于所有结局变量，心率变异系数的非线性和整体影响均不显着。在晚期急性期分析中观察到了相同的结果（n = 1576）。结论-在因急性缺血性卒中住院的心房纤颤患者中，急性卒中期间的平均心率与卒中复发无关，但与死亡率有关（非线性，J形关联）。关于心率变异性，未观察到心率与预后之间的关系。