We used the ESCAPE trial data to study the relationship between the magnitude of BNP reduction and various clinical and objective markers of decongestion.
Admission-to-discharge reduction in BNP was recorded in 245 patients who were divided into tertiles (tertile 1 had BNP reduction < 27 pg/mL, tertile 2 had BNP reduction 27–334 pg/mL and tertile 3 had BNP reduction > 334 pg/mL). There were significant differences across tertiles with regard to resolution of jugular venous distension (JVD, P = 0.014) and orthopnea (P = 0.04) on discharge, admission-to-discharge weight loss (P = 0.002), and admission-to-discharge reduction in inferior vena cava (IVC) diameter (P = 0.0001). Compared with the first tertile, patients in the third tertile had significantly higher frequency of resolution of JVD (univariate OR 2.657, P = 0.004) and orthopnea (univariate OR 2.083, P = 0.032) on discharge, more weight loss (P = 0.001), higher IVC diameter reduction (P < 0.0001), and higher reduction in pulmonary capillary wedge pressure (PCWP) from admission to day of PAC removal compared with first tertile (P < 0.0001). Using the whole cohort, we found a significant correlation between admission-to-discharge BNP reduction and admission-to-discharge weight loss (n = 232, r = 0.211, P = 0.001), admission-to-discharge reduction in IVC diameter (n = 99, r = 0.360, P < 0.0001) and reduction in PCWP from admission to the day of pulmonary artery catheter removal (n = 92, r = 0.242, P = 0.02).
Admission-to-discharge BNP reduction is a reasonable marker of treatment response in HF that correlated with clinical and objective markers of decongestion.