Persistent Maternal Cardiac Dysfunction After Preeclampsia Identifies Patients at Risk for Recurrent Preeclampsia

The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63 +/- 14 mL versus 73 +/- 12 mL and 70 +/- 11 mL, P<0.05), cardiac output (4.6 +/- 1.2 L versus 5.3 +/- 0.9 L and 5.2 +/- 1.0 L, P<0.05), higher E/E ratio (11.02 +/- 3.43 versus 7.34 +/- 2.11 versus 9.03 +/- 3.43, P<0.05), and higher total vascular resistance (1638 +/- 261 dynes(-1)cm(-5) versus 1341 +/- 270 dynes(-1)cm(-5) and 1383 +/- 261 dynes(-1)cm(-5), P<0.05). Left ventricular mass index was higher in both recurrent and nonrecurrent preeclampsia compared with controls (30.0 +/- 6.3 g/m(2.7) and 30.4 +/- 6.8 g/m(2.7) versus 24.8 +/- 5.0 g/m(2.7), P<0.05). Signs of diastolic dysfunction and different left ventricular characteristics are present in the nonpregnant state before a second pregnancy with recurrent preeclampsia. Previous preeclamptic patients with nonrecurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia.