Diastolic function in pregnant patients with cardiac symptoms

Dyspnea on exertion and peripheral edema occur routinely during normal gestational stage, making early diagnosis of congestive heart failure (CHF) during pregnancy difficult. Abnormal left ventricular (LV) diastolic function may be associated with dyspnea on exertion and peripheral edema, and brain natriuretic peptide (BNP) correlates with volume overload in nonpregnant populations. We tested the hypothesis that abnormal echocardiographic diastolic parameters and elevated BNP correlate in symptomatic pregnant patients.

Sixty-six gravidas presented to an Obstetric Cardiology Clinic were analyzed. Data including symptoms of CHF, BNP, and maternal and gestational ages were recorded. Echocardiograms were reviewed to measure the diastolic parameters E, A, e', and a' wave velocities and left atrial volume index (LAVI). Logistic regression was performed to characterize the relationship between diastolic parameters and BNP.

Among the 66 pregnant patients included in the analysis, only 6 were found to have significant LV systolic dysfunction. LAVI, E, and E/e' ratio correlated positively with BNP in this symptomatic population (p = 0.008, 0.007, and 0.002, respectively).

Abnormal diastolic parameters that represent increased LV filling pressures correlated with higher BNP levels in pregnant patients with symptoms of CHF. This suggests that symptoms may be due to diastolic dysfunction, and BNP levels may identify elevated LV filling pressures in symptomatic pregnant patients.