Abstract Body: Introduction: Preeclamptic (PE) patients are at a 4-fold higher risk for developing heart failure later in life. Pathological cardiac remodeling, and the ensuing left ventricular (LV) dysfunction during hypertensive pregnancy are thought to precede heart failure in these patients. Specifically, several observational studies employing echocardiography demonstrate exaggerated LV diastolic function alterations in PE patients suggestive of diastolic dysfunction. Objective: Thus, to consolidate the evidence supporting diastolic dysfunction in preeclampsia, we sought to systematically review the clinical literature, and conduct a meta-analysis on the pooled data pertaining to LV diastolic function. Methods: Three databases, MEDLINE (Ovid), Embase (Elsevier), and Scopus (Elsevier) were searched from inception to January 26, 2024 and the search results were uploaded to Covidence for screening. The diastolic function data—early diastole mitral flow to annulus velocity ratio (E/e’), isovolumic relaxation time (IVRT), early to late diastole mitral flow velocity ratio (E/A), and E wave deceleration time (DT)—were extracted, and subsequently used to perform meta-analysis using Cochrane’s RevMan Web (Mean Difference, MD; random effects models with inverse variance weighting). Results: A total of 63 from 5013 screened studies were eligible for inclusion and of these, only the studies reporting E/e’ (34/63), IVRT (18/63), E/A (38/63), and DT (16/63) were included in the meta-analysis. Our analysis showed that E/e’ is increased (MD of 2.33 [95% CI, 1.77 to 2.89], p<0.00001) in PE patients when compared to healthy pregnant women indicating elevated LV filling pressures. Further, PE patients exhibited significantly higher IVRT (MD of 8.88 msec [95% CI, 6.07 to 11.68], p<0.00001) and lower E/A (MD of -0.16 [95% CI, -0.25 to -0.06], p=0.001), collectively suggesting that the myocardial relaxation is impaired in preeclampsia. Interestingly, DT (MD of 3.10 msec [95% CI, -5.43 to 11.62], p=0.48) was not found to be different between the groups. Conclusions: Our findings demonstrate that PE patients develop LV diastolic dysfunction during pregnancy which may be mediated by hypertension caused pressure overload. Given that diastolic dysfunction is a hallmark characteristic of heart failure with preserved ejection fraction (HFpEF), future longitudinal studies examining cardiac function during pregnancy and postpartum will help determine if PE patients are destined to develop HFpEF.