Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease

OBJECTIVE: To compare early-pregnancy changes in cardiac diastolic function between formerly pre-eclamptic women with (RECUR) and without (NORECUR) recurrent pre-eclampsia. DESIGN: Retrospective observational cohort study. SETTING: Tertiary referral centre. POPULATION: Pregnant women with a history of early-onset pre-eclampsia (n = 34). METHODS: The peak mitral filling velocity in early diastole (E) and at atrial contraction (A), and the E/A ratio were assessed before and at 12, 16 and 20 weeks of gestation in the next pregnancy. Differences in early-pregnancy alterations between women with (RECUR) and without (NORECUR) recurrent pre-eclampsia were evaluated by use of mixed design analysis of covariance. MAIN OUTCOME MEASURES: Cardiac function and recurrent pre-eclampsia. RESULTS: In ten women (29%) pre-eclampsia recurred. By 12 weeks of gestation the E/A ratio had increased in the RECUR group, but not in the NORECUR group (P < 0.01). Moreover, from 16 weeks of gestation onwards, the RECUR group had a lower cardiac output and higher systemic vascular resistance as compared with the NORECUR group (P < 0.05). CONCLUSION: Our results suggest that formerly pre-eclamptic women destined to develop recurrent pre-eclampsia differ from their counterparts who do not develop recurrent pre-eclampsia by impaired first-trimester adaptation of cardiac diastolic function.