Cardiac Structure and Function in Women After Preeclampsia: A Systematic Review and Meta-Analysis.

BACKGROUND

Preeclampsia increases the risk of long-term heart failure (HF) by 4-fold. Unfortunately, however, universal guidelines for postpartum HF surveillance are lacking. Stage B/subclinical HF has been shown to predict risk of major adverse cardiac outcomes. Some suggest that initiating cardioprotective therapy at this early stage can reduce progression to symptomatic HF.

OBJECTIVES

The aim of this review was to explore cardiac structure and function in women with a history of preeclampsia and to identify when subclinical HF develops in this group.

METHODS

A systematic search of MEDLINE, EMBASE and CINAHL was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify all studies assessing left ventricular function on transthoracic echocardiography in women with a history of preeclampsia.

RESULTS

A total of 45 case-control studies comprising 8,991 women, including 2,288 women with a history of preeclampsia, were included in the final analysis. During pregnancy, women with preeclampsia had a higher left ventricular mass index (LVMI) (standard mean difference: 10.85 [95% CI: 6.30-15.39]), relative wall thickness (0.05 [95% CI: 0.03-0.08]), E/e' (1.58 [95% CI: 1.02-2.13]), isovolumetric relaxation time (8.74 [95% CI: 3.14-14.34]), lower E/A ratio (-0.27 [95% CI: -0.51 to -0.04]) and reduced absolute global longitudinal strain (GLS) values (2.27 [95% CI: 0.43-4.11]), indicating reduced myocardial function compared with normotensive controls. Postpartum, GLS remained reduced, and LVMI remained elevated in women with a history of preeclampsia. This difference persisted out to 10 years postpartum. There was no significant difference in all other variables >6 months postpartum. Evidence for persistent LVMI elevation >6 months postpartum was not robust in sensitivity analyses excluding overlapping cohorts. Left ventricular ejection fraction and right ventricular function remained similar in the preeclampsia and control groups throughout.

CONCLUSIONS

Preeclampsia is associated with subclinical myocardial dysfunction, characterized by impaired GLS and increased LVMI. Persistent impairment in GLS was observed up to 10 years postpartum, whereas the association with elevated LVMI beyond 6 months postpartum should be interpreted with caution. Further studies are required to assess when subclinical myocardial dysfunction progresses to symptomatic clinical HF.