{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T20:33:02Z","timestamp":1769113982704,"version":"3.49.0"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82100273"],"award-info":[{"award-number":["82100273"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82100347"],"award-info":[{"award-number":["82100347"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"crossref","award":["2020M673016"],"award-info":[{"award-number":["2020M673016"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"crossref","award":["2021M703724"],"award-info":[{"award-number":["2021M703724"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"crossref","award":["2022A1515010582"],"award-info":[{"award-number":["2022A1515010582"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>\n            Background\u2003Heart failure (HF) with preserved ejection fraction (HFpEF) is associated with increased risks of stroke and other adverse outcomes.<\/jats:p><jats:p>\n            Aims\u2003This study sought to determine whether the Essen Stroke Risk Score (ESRS) could predict the risks of adjudicated clinical outcomes in patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial.<\/jats:p><jats:p>\n            Methods\u2003We evaluated associations of baseline ESRS with clinical outcomes by using the Cox proportional hazard model with competing risk regression. The diagnostic accuracy of the ESRS was assessed using the C-index and calibration data.<\/jats:p><jats:p>\n            Results\u2003Of 3,441 HFpEF patients with a mean follow-up of 3.3 years, the risk of stroke ranged from 0.32% per year at an ESRS of 1 to 2 points to 1.71% per year at a score of \u22656 points. Each point increase in ESRS was associated with increased risks of primary composite outcome (hazard ratios [HRs]\u2009=\u20091.31; 95% confidence intervals [CIs]: 1.23\u20131.40; C-index\u2009=\u20090.68), stroke (HR\u2009=\u20091.33 [95% CI: 1.16\u20131.53]; C-index\u2009=\u20090.68), myocardial infarction (HR\u2009=\u20091.60 [95% CI: 1.40\u20131.83]; C-index\u2009=\u20090.75), HF hospitalization (HR\u2009=\u20091.30 [95% CI: 1.20\u20131.41]; C-index\u2009=\u20090.71), any hospitalization (HR\u2009=\u20091.20, 95% CI: 1.15\u20131.26; C-index\u2009=\u20090.68), cardiovascular death (HR\u2009=\u20091.32 [95% CI: 1.20\u20131.44]; C-index\u2009=\u20090.68), and all-cause death (HR\u2009=\u20091.37, [95% CI: 1.28\u20131.48]; C-index\u2009=\u20090.68). The calibration curves showed that the ESRS had a better agreement between predicted and observed stroke risks compared with the R2CHADS2, CHADS2, or CHA2DS2-VASC stroke scores.<\/jats:p><jats:p>\n            Conclusion\u2003The ESRS had modest discriminatory abilities for predicting stroke as well as other adverse outcomes including myocardial infarction, hospitalization, and death in HFpEF patients. ESRS might have better calibration performance than R2CHADS2, CHADS2, or CHA2DS2-VASC in HFpEF at high risk for stroke.<\/jats:p><jats:p>\n            Clinical Trial Registration\u2003URL: https:\/\/clinicaltrials.gov. Unique identifier: NCT00094302.<\/jats:p>","DOI":"10.1055\/a-1932-8854","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T23:04:02Z","timestamp":1661814242000},"page":"085-096","source":"Crossref","is-referenced-by-count":7,"title":["Essen Stroke Risk Score Predicts Clinical Outcomes in Heart Failure Patients with Preserved Ejection Fraction: Evidence from the TOPCAT trial"],"prefix":"10.1055","volume":"123","clinical-trial-number":[{"clinical-trial-number":"nct00094302","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Wengen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China"},{"name":"NHC Key Laboratory of Assisted Circulation, Guangzhou, People's Republic of China"},{"name":"National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yalin","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China"},{"name":"NHC Key Laboratory of Assisted Circulation, Guangzhou, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiling","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuzhong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianyong","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yugang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China"},{"name":"NHC Key Laboratory of Assisted Circulation, Guangzhou, People's Republic of China"},{"name":"National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China"},{"name":"NHC Key Laboratory of Assisted Circulation, Guangzhou, People's Republic of China"},{"name":"National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom"},{"name":"Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,11,7]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1161\/CIRCRESAHA.121.318172","article-title":"Epidemiology of heart failure: a contemporary perspective","volume":"128","author":"V L Roger","year":"2021","journal-title":"Circ Res"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1002\/ehf2.13264","article-title":"Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type","volume":"8","author":"J S Uhm","year":"2021","journal-title":"ESC Heart Fail"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.amjcard.2019.09.035","article-title":"Stroke and systemic embolism and other adverse outcomes of heart failure with preserved and reduced ejection fraction in patients with atrial fibrillation (from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF])","volume":"125","author":"S Chung","year":"2020","journal-title":"Am J Cardiol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jchf.2019.09.002","article-title":"HFpEF is the substrate for stroke in obesity and diabetes independent of atrial fibrillation","volume":"8","author":"M Packer","year":"2020","journal-title":"JACC Heart Fail"},{"key":"ref5","first-page":"CD003336","article-title":"Anticoagulation versus placebo for heart failure in sinus rhythm","volume":"5","author":"E Shantsila","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"3393","DOI":"10.1161\/STROKEAHA.119.025831","article-title":"Essen risk score in prediction of myocardial infarction after transient ischemic attack or ischemic stroke without prior coronary artery disease","volume":"50","author":"M Boulanger","year":"2019","journal-title":"Stroke"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"2491","DOI":"10.1161\/STROKEAHA.115.009912","article-title":"Recurrent stroke: the value of the CHA2DS2VASc score and the Essen stroke risk score in a nationwide stroke cohort","volume":"46","author":"S D Andersen","year":"2015","journal-title":"Stroke"},{"issue":"12","key":"ref8","doi-asserted-by":"crossref","first-page":"3619","DOI":"10.1161\/STROKEAHA.111.624148","article-title":"Validation of the Essen stroke risk score and the stroke prognosis instrument II in Chinese patients","volume":"42","author":"X Meng","year":"2011","journal-title":"Stroke"},{"issue":"15","key":"ref9","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1056\/NEJMoa1313731","article-title":"Spironolactone for heart failure with preserved ejection fraction","volume":"370","author":"B Pitt","year":"2014","journal-title":"N Engl J Med"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1002\/clc.22435","article-title":"The HAS-BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: a systematic review and meta-analysis","volume":"38","author":"W Zhu","year":"2015","journal-title":"Clin Cardiol"},{"issue":"20","key":"ref11","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1161\/CIRCULATIONAHA.106.661397","article-title":"Risk of thromboembolism in heart failure: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)","volume":"115","author":"R S Freudenberger","year":"2007","journal-title":"Circulation"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ijcard.2018.04.093","article-title":"Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: the PREFER in AF - 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