title: Prevalence of asymptomatic heart failure in formerly pre-eclamptic women: a cohort study.
abstract: OBJECTIVE
  After pre-eclampsia (PE), the prevalence of structural heart disease without symptoms, i.e. heart failure Stage B (HF-B), may be as high as one in four women in the first year postpartum. We hypothesize that a significant number of formerly pre-eclamptic women with HF-B postpartum are still in their resolving period and will not have HF-B during follow-up.
  
  
  METHODS
  In this prospective longitudinal cohort study, we included 69 formerly pre-eclamptic women who underwent serial echocardiographic measurements at 1 and 4 years postpartum. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m2), concentric remodeling (relative wall thickness > 0.42 and LVMi ≤ 95 g/m2), mild systolic dysfunction (left ventricular ejection fraction > 40% and < 55%) or asymptomatic valvular disease. Women were subdivided and analyzed according to HF-B outcome: no HF-B at either visit; HF-B at first visit only; HF-B at second visit only; HF-B at both visits.
  
  
  RESULTS
  The prevalence of HF-B in formerly pre-eclamptic women was 23% in the first year postpartum and 23% after 4 years. At the second visit, HF-B had resolved in 62.5% of affected women but was newly developed in 19% of initially unaffected women. At the first visit, 56% of women diagnosed with HF-B had reduced systolic function whereas at the second visit 69% of women with HF-B had concentric remodeling with mostly normal ejection fraction, consistent with diastolic dysfunction.
  
  
  CONCLUSIONS
  The prevalence of HF-B can be considered consistently high (1 in 4) amongst formerly pre-eclamptic women at follow-up. Nonetheless, at an individual level, more than 60% of women found initially to be affected by HF-B will recover, whilst about 20% of formerly pre-eclamptic women with normal echocardiography in the first year postpartum will develop HF-B over the following years. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: N M
authors.initials: NM
authors.lastname: Breetveld
authors.affiliation: Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Ghossein-Doha
authors.affiliation: Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: S M J
authors.initials: SM
authors.lastname: van Kuijk
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: van der Vlugt
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Heidema
authors.affiliation: Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Neer
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: van Empel
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: H-P
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: R R
authors.initials: RR
authors.lastname: Scholten
authors.affiliation: Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: M E A
authors.initials: ME
authors.lastname: Spaanderman
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies
keywords: HFpEF; cardiovascular disease; echocardiography; heart failure; pre-eclampsia