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Huaishun Wang,1,* Chi Zhang,2,* Longdong Xu,3,* Jiaping Xu,1,* Guodong Xiao1,* 1Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People’s Republic of China; 2Department of Neurology, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, Jiangsu, 215000, People’s Republic of China; 3Department of Neurology, The Fifth People’s Hospital of Changshu, Changshu, Jiangsu, 215500, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guodong Xiao; Jiaping Xu, Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People’s Republic of China, Email yarrowshaw@hotmail.com; simba481@163.comBackground and Purpose: Elevated heart rate (HR) after mechanical thrombectomy (MT) was associated with an increased risk of adverse outcomes. However, optimal HR management after MT remains unclear. This study aimed to identify patient subgroups with distinct HR trajectories after MT and explore their association with outcomes.Methods: Acute ischemic stroke patients undergoing MT therapy were prospectively recruited from July 2020 to December 2022. Their heart rate indicators were collected every hour for 72 hours after MT procedure. Latent variable mixture modeling was used to separate subjects into five groups with distinct HR trajectories. The primary outcome was poor functional outcome (mRS score > 2) at 3 months. Additional outcome was all-cause mortality (mRS score = 6) at 3 months.Results: A total of 224 patients with large vessel occlusion were enrolled, with a mean age of 65.2+14.0 years. Eighty-seven patients had a good functional outcome, and 137 patients had a poor functional outcome. Five distinct HR trajectories were observed: low (19.2%), moderate (33.0%), rapidly stabilized HR group (20.5%), persistently high HR group (21.0%), and very high HR group (6.3%). After adjusting for potential confounders, the HR trajectory group was independently associated with poor functional outcome at 3 months (P for interaction = 0.022). The risk of having poor functional outcome was increased in the rapidly stabilized HR group (odds ratio, 3.18 [95% confidence interval, 1.10– 9.19]), the persistently high HR group (odds ratio, 5.55 [95% confidence interval, 1.72– 17.87]) and very high HR group (odds ratio, 18.32 [95% confidence interval, 2.20– 95.52]) but not in the moderate group (odds ratio, 1.50 [95% confidence interval, 0.61– 3.69]), when compared with the low HR group. No significant association was found between trajectory group and 3-month all-cause mortality.Conclusion: HR during the first 72 hours after MT may be categorized into distinct trajectory groups, which differ in relation to poor functional outcome event risks. The findings may help to recognize potential candidates for future HR control trials.Key words: ischemic stroke, heart rate trajectory, mechanical thrombectomy, outcome

Abstract The heart rate (HR) trajectory is a dynamic metric that shows how HR changes over time. Previous studies have demonstrated that elevated HR is associated with stroke events. However, little research has been done on the influence of shifting HR throughout the acute period on clinical outcomes. This study aims to investigate the effect of HR trajectories on functional outcomes in patients with acute ischemic stroke (AIS). A total of 981 AIS patients were included in the study. A latent mixture model was used to assess HR trends over the first 7 days following disease onset. The patients were divided into four groups based on different HR trajectories: markedly decreasing in 48 h (T1), mildly decreasing in 48 h (T2), sustained moderate in 7 days (T3), and sustained high in 7 days (T4). Poor outcome was defined as a modified Rankin Scale (mRS) score of ≥3 in 3 months. Logistic regression was used to analyze the correlation between different HR trajectories and outcomes. The incidence of poor outcomes was 9.02%, 10.80%, 11.79%, 16.36% in T1 (n = 133), T2 (n = 352), T3 (n = 441), and T4 (n = 55) groups, respectively. Compared with T1 group, T4 group was significantly associated with a higher risk of poor outcome at 3 months (odds ratio = 3.00, 95% confidence interval = 1.06–8.54, p value = .0392). This suggests that in AIS patients, a sustained high HR trajectory is linked to a greater likelihood of poor functional outcome than a markedly decreasing HR trajectory. HR trajectories demonstrate the utility of repeated HR measurements for outcome assessment.

The heart rate (HR) trajectory is a dynamic metric that shows how HR changes over time. Previous studies have demonstrated that elevated HR is associated with stroke events. However, little research has been done on the influence of shifting HR throughout the acute period on clinical outcomes. This study aims to investigate the effect of HR trajectories on functional outcomes in patients with acute ischemic stroke (AIS). A total of 981 AIS patients were included in the study. A latent mixture model was used to assess HR trends over the first 7 days following disease onset. The patients were divided into four groups based on different HR trajectories: markedly decreasing in 48 h (T1), mildly decreasing in 48 h (T2), sustained moderate in 7 days (T3), and sustained high in 7 days (T4). Poor outcome was defined as a modified Rankin Scale (mRS) score of ≥3 in 3 months. Logistic regression was used to analyze the correlation between different HR trajectories and outcomes. The incidence of poor outcomes was 9.02%, 10.80%, 11.79%, 16.36% in T1 (n = 133), T2 (n = 352), T3 (n = 441), and T4 (n = 55) groups, respectively. Compared with T1 group, T4 group was significantly associated with a higher risk of poor outcome at 3 months (odds ratio = 3.00, 95% confidence interval = 1.06–8.54, p value =.0392). This suggests that in AIS patients, a sustained high HR trajectory is linked to a greater likelihood of poor functional outcome than a markedly decreasing HR trajectory. HR trajectories demonstrate the utility of repeated HR measurements for outcome assessment. [ABSTRACT FROM AUTHOR]

Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013.The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18–2.76]) and 1.45 (95% CI [0.67–3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment.

Background: Heart rate trajectory with multiple heart rate measurements is considered to be a more sensitive predictor of outcomes than single heart rate measurements. The association of heart rate trajectory patterns with acute heart failure outcomes has not been well studied. We examined the association of heart rate trajectory patterns with post-discharge outcomes., Methods: This prospective cohort study was based on an acute heart failure registry in Taiwan. A total of 1509 patients were enrolled in the Taiwan Society of Cardiology - Heart Failure with Reduced Ejection Fraction Registry from May 2013 to October 2015. The outcomes were post-discharge all-cause mortality and heart failure re-admission., Results: Two heart trajectory patterns were identified in group-based trajectory analysis. One started with a higher heart rate and had an increasing trend over 6 months then a subsequent decline (high-increasing-decreasing group; n = 352; 23.9%). The other started with a lower heart rate and had a relatively stable pattern (low-stable group; n = 1121; 76.1%). Compared with those in the low-stable group, patients in the high-increasing-decreasing group had a higher risk of events (all-cause mortality: hazard ratio 3.10 and 95% confidence interval 1.24-7.77; heart failure re-admission: hazard ratio 1.13 and 95% confidence interval 0.55-2.32)., Conclusions: Patients with a high-increasing-decreasing heart rate trajectory pattern had a higher risk of all-cause mortality than those with a low-stable pattern.