Longitudinal BNP follow-up as a marker of treatment response in acute heart failure: Relationship with objective markers of decongestion.

INTRODUCTION: Results of studies that examined the value of B-type natriuretic peptide (BNP) reduction as a marker of decongestion have been inconsistent. We investigated whether longitudinal admission-to-discharge BNP reduction can be used to monitor decongestion during acute heart failure (HF).

METHODS: We used the ESCAPE trial data to study the relationship between the magnitude of BNP reduction and various clinical and objective markers of decongestion.

RESULTS: Admission-to-discharge reduction in BNP was recorded in 245 patients who were divided into tertiles (tertile 1 had BNP reduction<27pg/mL, tertile 2 had BNP reduction 27-334pg/mL and tertile 3 had BNP reduction>334pg/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).

CONCLUSION: Admission-to-discharge BNP reduction is a reasonable marker of treatment response in HF that correlated with clinical and objective markers of decongestion.