1130 Heart failure with preserved ejection fraction: a diagnostic challenge in the peripartum setting

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a poorly understood but important diagnosis in peripartum women with clinical features of heart failure but a normal ejection fraction (EF). We identify patient characteristics associated with peripartum HFpEF and compare/ contrast it with pregnancy induced hypertension (PIH) to facilitate appropriate diagnosis and treatment. Women from 32 weeks of gestation to 7 months postpartum with dyspnea or significant edema and an EF ≥55% presenting to a tertiary care center from 2006-2017 were included. Those with missing delivery data were excluded. The Framingham HFpEF criteria were assessed for each patient based on chart review, as were demographics, comorbidities, labs, imaging, and clinical outcomes. Bivariate tests were performed across those with/ without HFpEF and PIH. A principle component analysis (PCA) was performed to identify latent relationships between HFpEF, PIH, and these variables. Of forty qualifying women, twenty-one (53%) independently met criteria for HFpEF or PIH; eleven women (27.5%) had presentations consistent with both conditions and nine (22.5%) had neither. Age, race, parity, delivery mode, relevant co-morbidities, mean BNP, and ECHO parameters did not significantly differ between those with/ without PIH or HFpEF (see Table 1). Neurologic symptoms were significantly associated with PIH (P<0.01). In the PCA (Figure 1), chronic hypertension, dyslipidemia, diastolic dysfunction, pulmonary edema, and being delivered for PIH were associated with both PIH and HFpEF. Headaches, visual changes, smoking, vaginal delivery, and being treated with magnesium intrapartum were distinctive to PIH. A history of sleep apnea and multiparity were specific to HFpEF. PIH and HFpEF are clinically similar conditions with different treatments and obstetric implications. Neurologic symptoms were the most specific to PIH in our data. Nulliparity was also a distinctive risk factor for PIH, as sleep apnea was for HFpEF. Attending to these factors may assist in optimizing management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)