Supplementary Material for: Association between Rapid Ventricular Response and Stroke Outcomes in Atrial Fibrillation-Related Cardiac Embolic Stroke

Introduction: Patients with atrial fibrillation-related stroke (AF-stroke) are prone to developing rapid ventricular response (RVR). We investigated whether RVR is associated with initial stroke severity, early neurological deterioration (END) and poor outcome at 3 months. Methods: We reviewed patients who had AF-stroke between January 2017 and March 2022. RVR was defined as having heart rate >100 beats per minute on initial electrocardiogram. Neurological deficit was evaluated with National Institutes of Health Stroke Scale (NIHSS) score at admission. END was defined as increase of ≥2 in total NIHSS score or ≥1 in motor NIHSS score within first 72 h. Functional outcome was score on modified Rankin Scale at 3 months. Mediation analysis was performed to examine potential causal chain in which initial stroke severity may mediate relationship between RVR and functional outcome. Results: We studied 568 AF-stroke patients, among whom 86 (15.1%) had RVR. Patients with RVR had higher initial NIHSS score (p p = 0.004) than those without RVR. The presence of RVR [adjusted odds ratio (aOR) = 2.13; p = 0.013] was associated with initial stroke severity, but not with END and functional outcome. Otherwise, initial stroke severity [aOR = 1.27; p = Conclusion: In patients with AF-stroke, RVR was independently associated with initial stroke severity but not with END and functional outcome. Initial stroke severity mediated considerable proportion of association between RVR and functional outcome.

引言：房颤相关性卒中（atrial fibrillation-related stroke, AF-stroke）患者易出现快速心室反应（rapid ventricular response, RVR）。本研究旨在探讨RVR是否与卒中初始严重程度、早期神经功能恶化（early neurological deterioration, END）及3个月不良预后相关。
方法：我们回顾性分析了2017年1月至2022年3月期间收治的AF-stroke患者。RVR定义为初始心电图提示心率＞100次/分。入院时采用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评估神经功能缺损情况。END定义为发病72小时内总NIHSS评分升高≥2分，或运动项NIHSS评分升高≥1分。3个月时采用改良Rankin量表（modified Rankin Scale, mRS）评分评估功能预后。本研究采用中介分析以检验初始卒中严重程度是否介导RVR与功能预后之间的潜在因果关联。
结果：本研究共纳入568例AF-stroke患者，其中86例（15.1%）存在RVR。与无RVR的患者相比，RVR患者的初始NIHSS评分更高（P=0.004）。RVR的存在与初始卒中严重程度相关[校正比值比（adjusted odds ratio, aOR）=2.13；P=0.013]，但与END及功能预后无显著关联。此外，初始卒中严重程度[aOR=1.27；P=]
结论：在AF-stroke患者中，RVR与初始卒中严重程度独立相关，但与END及功能预后无显著关联。初始卒中严重程度介导了RVR与功能预后之间关联的相当一部分比例。