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.

Background: Dyspnea is common in pregnancy and difficult to assess in the emergency department (ED), as it may reflect physiological adaptation or cardiopulmonary pathology. We evaluated whether novel BNP-derived uric acid composite indices aid the assessment of dyspnea in late pregnancy; to our knowledge, this is the first study of such indices in this setting. Methods: In this prospective observational study, third-trimester pregnant women (≥27 weeks) presenting to the ED with dyspnea were compared with age-matched asymptomatic pregnant controls. All underwent laboratory testing (including BNP, D-dimer, and uric acid) and standardised transthoracic echocardiography. Three composite indices were calculated (BNP/Albumin, BNP/Uric acid, and BNP × Uric acid), and diagnostic performance was assessed by receiver operating characteristic (ROC) analysis. Results: A total of 215 women were included (100 dyspnea, 115 controls). The dyspnea group had significantly higher D-dimer, BNP, uric acid, and all three composite indices (all p < 0.001), together with higher systolic pulmonary artery pressure (sPAP), right atrial and ventricular diameters, and lateral E/e′. Uric acid (AUC 0.998), the BNP × Uric acid product (AUC 0.846), and sPAP (AUC 0.836) showed the strongest discrimination; the BNP × Uric acid product outperformed BNP, D-dimer, and BNP/Albumin individually but did not surpass uric acid alone. Conclusions: Dyspneic third-trimester women show subtle but significant cardiopulmonary changes despite values that largely remain within normal ranges. These changes distinguished symptomatic from asymptomatic pregnancy but remained largely within normal ranges and do not by themselves identify acute cardiopulmonary disease; uric acid alone was the strongest discriminator, and the composite indices are proposed only as hypothesis-generating tools requiring external validation, ideally against dyspnoeic pregnant women with confirmed pathology.