Comparison of Maternal Echocardiographic Findings in Women with Early Onset Preeclampsia and Late Onset Preeclampsia: A Prospective Observational Study

Introduction: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Significant cardiovascular adaptations occur in preeclampsia, with Early Onset Preeclampsia (EOPE, onset before 34 weeks of gestation) associated with a more complex and severe haemodynamic profile compared to Late Onset Preeclampsia (LOPE, onset at or after 34 weeks). Recent evidence indicates that EOPE and LOPE represent distinct pathophysiological entities characterised by different haemodynamic states, necessitating subtype-specific cardiovascular risk assessment during the antenatal period. Aim: To compare echocardiographic findings in women with EOPE versus those with LOPE and to characterise differences in biventricular systolic and diastolic function between the two subtypes. Materials and Methods: A prospective observational study was conducted in 80 antenatal women (40 with EOPE and 40 with LOPE) at a tertiary care centre in Arunachal Pradesh from June 2021 to September 2022. Standard two-dimensional, M-mode, and Doppler transthoracic echocardiography was performed for all participants. Biventricular systolic function, Left Ventricular (LV) diastolic function, LV geometry, and Right Ventricular (RV) systolic function were assessed according to American and European Society of Echocardiography guidelines. Results: Impairment in LV Ejection Fraction (LVEF) was significantly more prevalent in EOPE compared with LOPE (42.5% versus 20%, p-value=0.03). Indices of LV diastolic dysfunction, including mitral E/A ratio, septal E/E’, and lateral E/E’, were significantly higher in EOPE (p-value=0.005, 0.015, and 0.011, respectively). Overall diastolic dysfunction was more frequent in EOPE than in LOPE (80% versus 55%, p=0.017). Tricuspid annular plane systolic excursion (TAPSE) was significantly lower in EOPE compared with LOPE (2.11±0.286 cm versus 2.45±0.523 cm, p-value <0.001), indicating RV longitudinal systolic dysfunction in EOPE. Relative LV wall thickness was significantly higher in EOPE (0.53±0.18 versus 0.45±0.12, p-value=0.026). Conclusion: Women with EOPE demonstrate significantly greater LV diastolic dysfunction and biventricular myocardial contractility impairment compared with LOPE. Echocardiography performed during the antenatal period can identify preeclamptic women at higher cardiovascular risk, particularly those with early onset disease, enabling patient-specific management and long-term cardiovascular surveillance.