Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 5, October 2026, pages 453-458

Concordance Between E/e’ Ratio and N-Terminal Pro-B-type Natriuretic Peptide Levels for Predicting Post-Discharge Heart Failure Events Within Ninety Days After Acute Coronary Syndrome

↓ Figure 1. Kaplan-Meier curves for post-discharge heart failure events within 90 days stratified by concordance between the E/e’ ratio and NT-proBNP level. Numbers at risk at days 0, 30, 60, and 90 were 34, 33, 32, and 32 in the concordantly low group; 69, 62, 59, and 58 in the discordant group; and 92, 78, 72, and 68 in the concordantly high group, respectively. NT-proBNP: N-terminal pro-B-type natriuretic peptide; HF: heart failure.

↓ **Table 1.** Baseline Clinical Characteristics According to Concordance Between E/e’ Ratio and NT-proBNP Level
Characteristic	Concordantly low (n = 34)	Discordant (n = 69)	Concordantly high (n = 92)	P value
Data are presented as n (%), mean (standard deviation), or median (interquartile range), as appropriate. P values with * are significant at alpha level of 0.05. ^aOne-way ANOVA; ^bChi-square; ^cFisher’s exact; ^dKruskal–Wallis. BMI: body mass index; NSTEMI: non–ST-segment elevation myocardial infarction; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction; SGLT2: sodium-glucose cotransporter 2; NT-proBNP: N-terminal pro-B-type natriuretic peptide; ANOVA: analysis of variance.
Age, years	61.5 (13.4)	68.6 (13.1)	71.7 (12.9)	< 0.001*^a
BMI, kg/m²	25.6 (3.5)	24.5 (4.6)	24.7 (4.7)	0.458^a
Hypertension	23 (67.6%)	54 (78.3%)	75 (81.5%)	0.248^b
Dyslipidemia	23 (67.6%)	53 (76.8%)	72 (78.3%)	0.454^b
Diabetes mellitus	13 (38.2%)	41 (59.4%)	46 (50.0%)	0.122^b
Coronary artery disease	9 (26.5%)	15 (21.7%)	25 (27.2%)	0.719^b
Chronic kidney disease	4 (11.8%)	23 (33.3%)	21 (22.8%)	0.050^b
NSTEMI	23 (67.6%)	47 (68.1%)	76 (82.6%)	0.037*^c
Killip class III–IV	2 (5.9%)	12 (17.4%)	23 (25.0%)	< 0.001*^b
eGFR, mL/min/1.73 m²	79.9 (61.0, 92.1)	63.3 (40.0, 86.5)	60.4 (42.5, 81.1)	0.011*^d
LVEF, %	50.0 (45.0, 60.0)	41.0 (30.0, 55.0)	34.0 (24.5, 42.0)	< 0.001*^d
SGLT2 inhibitor at discharge	3 (8.8%)	23 (33.3%)	33 (35.9%)	0.011*^b
Mineralocorticoid receptor antagonist at discharge	6 (17.6%)	20 (29.0%)	39 (42.4%)	0.021*^b

↓ Table 1. Baseline Clinical Characteristics According to Concordance Between E/e’ Ratio and NT-proBNP Level

Characteristic

Concordantly low (n = 34)

Discordant (n = 69)

Concordantly high (n = 92)

P value

Data are presented as n (%), mean (standard deviation), or median (interquartile range), as appropriate. P values with * are significant at alpha level of 0.05. ^aOne-way ANOVA; ^bChi-square; ^cFisher’s exact; ^dKruskal–Wallis. BMI: body mass index; NSTEMI: non–ST-segment elevation myocardial infarction; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction; SGLT2: sodium-glucose cotransporter 2; NT-proBNP: N-terminal pro-B-type natriuretic peptide; ANOVA: analysis of variance.

Age, years

61.5 (13.4)

68.6 (13.1)

71.7 (12.9)

< 0.001*^a

BMI, kg/m²

25.6 (3.5)

24.5 (4.6)

24.7 (4.7)

0.458^a

Hypertension

23 (67.6%)

54 (78.3%)

75 (81.5%)

0.248^b

Dyslipidemia

23 (67.6%)

53 (76.8%)

72 (78.3%)

0.454^b

Diabetes mellitus

13 (38.2%)

41 (59.4%)

46 (50.0%)

0.122^b

Coronary artery disease

9 (26.5%)

15 (21.7%)

25 (27.2%)

0.719^b

Chronic kidney disease

4 (11.8%)

23 (33.3%)

21 (22.8%)

0.050^b

NSTEMI

23 (67.6%)

47 (68.1%)

76 (82.6%)

0.037*^c

Killip class III–IV

2 (5.9%)

12 (17.4%)

23 (25.0%)

< 0.001*^b

eGFR, mL/min/1.73 m²

79.9 (61.0, 92.1)

63.3 (40.0, 86.5)

60.4 (42.5, 81.1)

0.011*^d

LVEF, %

50.0 (45.0, 60.0)

41.0 (30.0, 55.0)

34.0 (24.5, 42.0)

< 0.001*^d

SGLT2 inhibitor at discharge

3 (8.8%)

23 (33.3%)

33 (35.9%)

0.011*^b

Mineralocorticoid receptor antagonist at discharge

6 (17.6%)

20 (29.0%)

39 (42.4%)

0.021*^b

↓ **Table 2.** Post-Discharge Heart Failure Events Within 90 Days
Outcome	Total	Concordantly low	Discordant	Concordantly high
The log-rank P value was 0.036 for post-discharged HF events. HF: heart failure.
Post-discharged HF events, n (%)	33/195 (16.9%)	2/34 (5.9%)	9/69 (13.0%)	22/92 (23.9%)
Total person-days for primary outcome	15,302	2,943	5,495	6,864
Event rate per 1,000 person-days	2.16 (1.53–3.03)	0.68 (0.17–2.72)	1.64 (0.85–3.15)	3.21 (2.11–4.87)

↓ Table 2. Post-Discharge Heart Failure Events Within 90 Days

Outcome

Total

Concordantly low

Discordant

Concordantly high

The log-rank P value was 0.036 for post-discharged HF events. HF: heart failure.

Post-discharged HF events, n (%)

33/195 (16.9%)

2/34 (5.9%)

9/69 (13.0%)

22/92 (23.9%)

Total person-days for primary outcome

15,302

2,943

5,495

6,864

Event rate per 1,000 person-days

2.16 (1.53–3.03)

0.68 (0.17–2.72)

1.64 (0.85–3.15)

3.21 (2.11–4.87)

↓ **Table 3.** Cox regression Analysis for Post-Discharge HF Events Within 90 Days
Group	Univariable HR (95% CI)	P value	Reported adjusted HR (95% CI)	P value
The reported multivariable model was adjusted for age category, sex, eGFR, LVEF, sodium-glucose cotransporter-2 inhibitor use, and mineralocorticoid receptor antagonist use. HF: heart failure; HR: hazard ratio; CI: confidence interval; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction.
Concordantly low	Reference		Reference
Discordant	2.36 (0.51–10.93)	0.271	2.40 (0.49–11.73)	0.279
Concordantly high	4.50 (1.06–19.14)	0.042	5.97 (1.22–29.10)	0.027

↓ Table 3. Cox regression Analysis for Post-Discharge HF Events Within 90 Days

Group

Univariable HR (95% CI)

P value

Reported adjusted HR (95% CI)

P value

The reported multivariable model was adjusted for age category, sex, eGFR, LVEF, sodium-glucose cotransporter-2 inhibitor use, and mineralocorticoid receptor antagonist use. HF: heart failure; HR: hazard ratio; CI: confidence interval; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction.

Concordantly low

Reference

Discordant

2.36 (0.51–10.93)

0.271

2.40 (0.49–11.73)

0.279

Concordantly high

4.50 (1.06–19.14)

0.042

5.97 (1.22–29.10)

0.027

↓ **Table 4.** Secondary Outcomes
Outcome	Total	Concordantly low	Discordant	Concordantly high
Log-rank P values were 0.046 for all-cause mortality, and 0.028 for HF hospitalization. HF: heart failure.
All-cause mortality, n (%)	6/195 (3.1%)	0/34 (0.0%)	2/69 (2.9%)	4/92 (4.4%)
HF hospitalization, n (%)	17/195 (8.7%)	1/34 (2.9%)	5/69 (7.3%)	11/92 (12.0%)

↓ Table 4. Secondary Outcomes

Outcome

Total

Concordantly low

Discordant

Concordantly high

Log-rank P values were 0.046 for all-cause mortality, and 0.028 for HF hospitalization. HF: heart failure.

All-cause mortality, n (%)

6/195 (3.1%)

0/34 (0.0%)

2/69 (2.9%)

4/92 (4.4%)

HF hospitalization, n (%)

17/195 (8.7%)

1/34 (2.9%)

5/69 (7.3%)

11/92 (12.0%)