# Aortic Elastic Properties and Albumin-Based Inflammatory Indices in Dyspneic Third-Trimester Pregnant Women: A Prospective Observational Study

## TL;DR

This study found that dyspneic pregnant women in their third trimester have reduced aortic elasticity and higher inflammation markers compared to asymptomatic women.

## Contribution

The study introduces a practical approach using aortic elasticity and the CAR index for cardiovascular risk assessment in dyspneic pregnant women.

## Key findings

- Dyspneic women showed significantly lower aortic strain and distensibility and higher aortic stiffness compared to controls.
- CAR levels were elevated in dyspneic women, while other albumin-based indices did not differ significantly.
- Combined models of CAR and echocardiographic parameters improved predictive performance for dyspnea.

## Abstract

Background: Dyspnea is a frequent complaint during pregnancy and is often considered a benign physiological finding; however, it may also reflect underlying subclinical cardiovascular alterations. Pregnancy-related vascular remodeling and low-grade systemic inflammation may contribute to changes in aortic elastic properties and inflammatory biomarkers, particularly in symptomatic women. Objective: This study aimed to compare aortic elastic properties and albumin-based inflammatory indices between dyspneic and asymptomatic third-trimester pregnant women. A secondary aim was to establish reference values for echocardiographic and biomarker parameters in dyspneic pregnancy. Methods: In this prospective observational study, third-trimester pregnant women (≥27 gestational weeks) presenting to the emergency department (ED) with dyspnea were consecutively enrolled and compared with age-matched asymptomatic pregnant controls. Demographic, laboratory, and echocardiographic data were recorded. Aortic strain, aortic distensibility, and aortic stiffness were calculated using transthoracic echocardiography. Albumin-based inflammatory indices, including the hemoglobin–albumin–lymphocyte–platelet (HALP) score, prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), and RDW-to-albumin ratio (RAR), were analyzed. Receiver operating characteristic (ROC) and correlation analyses were performed. Results: A total of 241 pregnant women were included (121 dyspneic, 120 controls). Demographic characteristics were comparable between groups. Dyspneic pregnant women exhibited significantly lower aortic strain and aortic distensibility and higher aortic stiffness compared with controls (for all p < 0.05). Among laboratory parameters, CAR levels were significantly elevated in the dyspneic group (p < 0.001), whereas HALP, PNI, and RAR did not differ significantly. After adjustment for potential confounders, differences in aortic elastic properties remained significant. CAR demonstrated moderate discriminative ability for dyspnea (AUC = 0.692), while aortic elastic parameters showed modest predictive performance. In combined prediction models incorporating CAR with echocardiographic parameters, discriminatory performance improved, with area under the curve values exceeding 0.70. Weak positive correlations were observed between PNI and aortic strain and distensibility. Conclusions: Dyspneic third-trimester pregnant women exhibit impaired aortic elastic properties and increased CAR levels, suggesting the presence of subclinical vascular and inflammatory alterations. Assessment of aortic elasticity and CAR may provide a simple and practical approach for early cardiovascular risk stratification in symptomatic pregnancy, particularly in ED settings. Further multicenter studies with longitudinal follow-up are warranted to clarify their prognostic significance.