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• BMI affects the value of biomarkers and their clinical interpretation in AHF. • In obese BMI, low BNP does not suggest low risk for adverse events. • Hs-cTn predicted poor prognosis without being influenced by BMI. Body mass index (BMI) is a known confounder for natriuretic peptides, but its influence on other biomarkers is less well described. We investigated whether BMI interacts with biomarkers' association with prognosis in patients with acute heart failure (AHF). B-type natriuretic peptide (BNP), high-sensitivity cardiac troponin I (hs-cTnI), galectin-3, serum neutrophil gelatinase-associated lipocalin (sNGAL), and urine NGAL were measured serially in patients with AHF during hospitalization in the AKINESIS (Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic Heart Failure) study. Cox regression analysis was used to determine the association of biomarkers and their interaction with BMI for 30-day, 90-day and 1-year composite outcomes of death or HF readmission. Among 866 patients, 21.2%, 29.7% and 46.8% had normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) or obese (≥ 30 kg/m2) BMIs on admission, respectively. Admission values of BNP and hs-cTnI were negatively associated with BMI, whereas galectin-3 and sNGAL were positively associated with BMI. Admission BNP and hs-cTnI levels were associated with the composite outcome within 30 days, 90 days and 1 year. Only BNP had a significant interaction with BMI. When BNP was analyzed by BMI category, its association with the composite outcome attenuated at higher BMIs and was no longer significant in obese individuals. Findings were similar when evaluated by the last-measured biomarkers and BMIs. In patients with AHF, only BNP had a significant interaction with BMI for the outcomes, with its association attenuating as BMI increased; hs-cTnI was prognostic, regardless of BMI. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The six-minute walk test (6MWT) is widely used to measure exercise capacity; however, the magnitude of change that is clinically meaningful for individuals is not well established in heart failure with reduced ejection fraction (HFrEF).Objective: To calculate the minimal clinically important difference (MCID) for change in exercise capacity on the 6MWT in iron-deficient HFrEF populations.Methods: In this pooled secondary analysis of FAIR-HF and CONFIRM-HF trials, mean changes in 6MWT from baseline to weeks 12 and 24 were calculated and calibrated against the Patient Global Assessment (PGA) tool [clinical anchor] to derive MCIDs for improvement and deterioration.Results: Of 760 patients included in the two trials, 6MWT and PGA data were available for 680 (89%) and 656 (86%) patients at weeks 12 and 24, respectively. The mean 6MWT distance at baseline was 281±103m. There was a modest correlation between changes in 6MWT and PGA from baseline to week 12 (r=0.31, p<0.0001) and week 24 (r=0.43, p<0.0001). Respective estimates (95% confidence intervals) for MCID in 6MWT at weeks 12 and 24 were 14m (5;23) and 15m (3;27) for a "little improvement" (vs no change), 20m (10;30) and 24m (12;36) for "moderate improvement" vs a "little improvement", -11m (-32;9.2) and -31m (-53;-8) for a "little deterioration" (vs no change), and -84m (-144;-24) and -69m (-118;-20) for "moderate deterioration" vs a "little deterioration".Conclusions: The MCID for improvement in exercise capacity on the 6MWT was 14-15m in patients with HFrEF and iron deficiency. These MCIDs can aid clinical interpretation of study data. [ABSTRACT FROM AUTHOR]

Objective: We sought to compare labor patterns by body mass index (BMI). Study Design: A total of 118,978 gravidas with a singleton term cephalic gestation were studied. Repeated-measures analysis constructed mean labor curves by parity and BMI categories for those who reached 10 cm. Interval-censored regression analysis determined median traverse times, adjusting for covariates in vaginal deliveries and intrapartum cesareans. Results: In the labor curves, the time difference to reach 10 cm was 1.2 hours from the lowest to highest BMI category for nulliparas. Multiparas entered active phase by 6 cm, but reaching this point took longer for BMI ≥40.0 (3.4 hours) compared to BMI <25.0 (2.4 hours). Progression by centimeter (P < .001 for nulliparas) and from 4-10 cm (P < .001 for nulliparas and multiparas) increased as BMI increased. Second stage length, with and without an epidural, was similar among BMI categories for nulliparas (P > .05) but decreased as BMI increased for multiparas (P < .001). Conclusion: Labor proceeds more slowly as BMI increases, suggesting that labor management be altered to allow longer time for these differences. [ABSTRACT FROM AUTHOR]

Objective: We sought to assess body mass index (BMI) effect on cesarean risk during labor. Study Design: The Consortium on Safe Labor collected electronic data from 228,668 deliveries. Women with singletons ≥37 weeks and known BMI at labor admission were analyzed in this cohort study. Regression analysis generated relative risks for cesarean stratifying for parity and prior cesarean while controlling for covariates. Results: Of the 124,389 women, 14.0% had cesareans. Cesareans increased with increasing BMI for nulliparas and multiparas with and without a prior cesarean. Repeat cesareans were performed in >50% of laboring women with a BMI >40 kg/m2. The risk for cesarean increased as BMI increased for all subgroups, P < .001. The risk for cesarean increased by 5%, 2%, and 5% for nulliparas and multiparas with and without a prior cesarean, respectively, for each 1-kg/m2 increase in BMI. Conclusion: Admission BMI is significantly associated with delivery route in term laboring women. Parity and prior cesarean are other important predictors. [ABSTRACT FROM AUTHOR]