Decreased endothelial function and increased subclinical heart failure in women several years after pre‐eclampsia. (19th June 2018) - Breetveld, N. M.
ABSTRACT: Objectives: Pre‐eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF‐B). In this study, we assessed the relationship between endothelial function, measured by flow‐mediated dilation (FMD), and HF‐B in women with a history of PE. Methods: This was an observational study in which 67 formerly pre‐eclamptic 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 FMD. HF‐B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m 2 ), concentric remodeling (relative wall thickness > 0.42 and LVMi ≤ 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 pre‐eclamptic 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. Results: The prevalence of HF‐B amongst formerly pre‐eclamptic women was three‐fold higher than that observed for controls (25% vs 8%, P < 0.05), while FMD was lower in formerly pre‐eclamptic women compared with controls (6.12% vs 8.22%, P < 0.01); history of PE remained associated independently with lower FMD after adjusting for metabolic syndrome risk factors and obstetric parameters (β, –1.88; 95% CI, −3.59 to −0.18). However, HF‐B did not relate to low FMD in formerly pre‐eclamptic women. Conclusions: Years after pregnancy, formerly pre‐ eclamptic women have lower FMD and have HF‐B more often compared with healthy parous controls. Nonetheless, HF‐B was not related to reduced FMD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.