Decreased Endothelial Function and Increased Subclinical Heart Failure in Women Several Years after Pre-eclampsia

Preeclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure stage B (HF-B). This study assessed the relationship between endothelial function, along with components of metabolic syndrome, and asymptomatic structural heart dysfunction in formerly preeclamptic women and healthy parous controls.In this observational study, 67 formerly preeclamptic women (>= 4 years postpartum) and 37 healthy parous controls were assessed ultrasonographically for cardiac function and geometry, as well as for endothelial function by means of brachial artery flow-mediated dilation (FMD). Heart failure stage B was diagnosed as left ventricular hypertrophy (left ventricular mass index >95 g/m(2)), concentric remodeling (relative wall thickness >0.42 and left ventricular mass index <= 95 g/m(2)), mild systolic dysfunction (left ventricular ejection fraction >40% and <55%), or asymptomatic valvular disease. Cardiovascular and metabolic syndrome variables were compared between women with history of PE and controls, as well as between those in the formerly preeclamptic group who had HF stage A, HF-B, or no HF. Logistic regression analysis was performed to assess the associations of FMD with PE, metabolic syndrome risk factors, and obstetric parameters.This study is the first demonstration of the assumed association between endothelial dysfunction, measured by FMD, and prevalence of HF-B after PE. The study's findings showed that formerly preeclamptic women have lower endothelium-dependent FMD compared with women with a history of only normotensive gestation, indicating attenuated endothelial function in the formerly preeclamptic group. Moreover, compared with controls, formerly preeclamptic women had an 8-fold higher prevalence of cardiovascular risk factor (HF-A) and 3-fold higher prevalence of HF-B. Nonetheless, the study did not observe any association between endothelial dysfunction and the prevalence of HF-A or HF-B in formerly preeclamptic women.In conclusion, the study found lower FMD in formerly preeclamptic women 5 to 8 years postpartum as compared with women with a history of healthy pregnancy. Formerly preeclamptic women had an 8-fold higher prevalence of HF-A and a 3-fold higher prevalence of HF-B compared with controls. However, no difference in FMD was found between former PE patients with HF-B and those without, suggesting different mechanisms underlying the subclinical stages of HF.