Clinical Investigation

Postpartum Detection of Diastolic Dysfunction and

Nondipping Blood Pressure Profile in Women With
Preeclampsia
Marwa Sayed, MD1; Mariam Rashed, MSc1; Ahmed M. Abbas, MD2; Amr Youssef, MD1; Mohamed Abdel Ghany, MD1
1Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
2Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt

Abstract
Background: Left ventricular diastolic dysfunction and nocturnal “nondipping” of blood pressure detected
via ambulatory blood pressure monitoring are predictors of increased cardiovascular morbidity.
Methods: A prospective cohort study including normotensive women with a history of preeclampsia in their
current pregnancy was conducted. All cases were subjected to 24-hour ambulatory blood pressure monitor-
ing and 2-dimensional transthoracic echocardiography 3 months after delivery.
Results: This study included 128 women with a mean (SD) age of 28.6 (5.1) years and a mean (SD) basal
blood pressure of 123.1 (6.4)/74.6 (5.9) mm Hg. Among the participants, 90 (70.3%) exhibited an ambula-
tory blood pressure monitoring profile illustrating nocturnal blood pressure “dipping” (the mean night to day
time blood pressure ratio ≤ 0.9), whereas 38 (29.7%) were nondippers. Diastolic dysfunction (impaired left
ventricular relaxation) was present in 28 nondippers (73.7%), whereas none of the dippers exhibited diastolic
dysfunction. Women with severe preeclampsia were more frequently nondippers (35.5% vs 24.2%; P = .02)
and experienced diastolic dysfunction (29% vs 15%; P = .01) than were those with mild preeclampsia. Severe
preeclampsia (odds ratio [OR], 1.08; 95% CI, 1.05-10.56; P < .001) and history of recurrent preeclampsia (OR,
1.36; 95% CI, 1.3-4.26; P ≤ .001) were significant predictors for nondipping status and diastolic dysfunction
(OR, 1.55; 95% CI, 1.1-2.2; and OR, 1.23; 95% CI, 1.2-2.2, respectively; P < .05).
Conclusion: Women with a history of preeclampsia were at higher risk for developing late cardiovascular
events. The severity and recurrence of preeclampsia were significant predictors of both nondipping profile
and diastolic dysfunction.

Keywords: Pre-eclampsia; blood pressure monitoring, ambulatory; echocardiography; ventricular dysfunction

Introduction

P
reeclampsia (PE) is a disorder characterized by new-onset hypertension and proteinuria during pregnancy,
complicating 2% to 8% of all pregnancies.1
Excessive inflammatory reaction and endothelial damage, accompanied by a wide range of multiorgan
dysfunctions, are the main manifestations of PE.2 Multiple studies have been conducted to investigate the influence
of PE on maternal cardiovascular (CV) function and structure. Some reports have shown that the impact of PE
recovered a few weeks postpartum,3 although women with a history of PE are still at increased risk of future CV
events,4 which suggests the need for preventive strategies among these women.5,6
Better targeting of the implementation of these strategies might be achieved by improving the process of identifying
the women at highest risk. A few studies have reported cardiac remodeling and nocturnal hypertension in some
patients with previous PE, which are correlated with CV morbidity and mortality.4,7-11

Citation: Sayed M, Rashed M, Abbas AM, Youssef A, Ghany MA. Postpartum detection of diastolic dysfunction and nondipping blood
pressure profile in women with preeclampsia. Tex Heart Inst J. 2023;50(3):e207459. doi:10.14503/THIJ-20-7459
Corresponding author: Marwa Sayed, MD, Department of Cardiovascular Medicine, Assiut University, PO Box 71515, Assiut, Egypt
([email protected])
© 2023 by The Texas Heart® Institute, Houston

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Sayed, et al Preeclampsia Beyond Pregnancy

Tissue Doppler imaging (TDI) can better detect left

ventricular (LV) myocardial remodeling than can Abbreviations and Acronyms
conventional Doppler examination; moreover, TDI 2D 2-dimensional
has been strongly correlated with invasive indices of ABPM ambulatory blood pressure monitoring
myocardial filling pressures and long-term CV risk.12 Amax maximum atrial filling
Ambulatory blood pressure monitoring (ABPM) has AUC area under the curve
BP blood pressure
been closely correlated with target organ damage and
CV cardiovascular
future CV events.13-16 Therefore, the current study asses-
DBP diastolic blood pressure
sed the cardiac function and blood pressure (BP) pat- EF ejection fraction
tern in postpartum women with PE to identify possible Emax maximum elastance
predictors of future CV risk at 12 weeks postpartum. LV left ventricle
OR odds ratio
PE preeclampsia
Patients and Methods SBP systolic blood pressure
TDI tissue Doppler imaging

Study Type, Setting, and Duration

This prospective cohort study was performed at a 20 weeks’ gestation associated with multiorgan involve-
tertiary university hospital between May 2017 and June ment.17
2019. The institutional review board approved the study
protocol. The study was conducted in accordance with Ambulatory Blood Pressure Monitoring
the ethical guidelines for human studies. After receiving Mean SBP and DBP, mean arterial pressure, and BP
an explanation regarding the nature of the procedure, load values were obtained for a full 24 hours via ABPM.
all study participants provided informed consent. Dipping status was defined as the percentage of reduc-
tion of nocturnal BP as recommended by the European
Study Participants Society of Hypertension practice guidelines for ABPM.18
Women between ages 18 and 40 years with a history of Accordingly, those with normal dipping status were
PE during their current pregnancy were included in the those whose nocturnal BP shows at least a 10% decline
study. All women were enrolled within their first week compared with their daytime BP (mean nighttime to
postpartum. We excluded patients who had chronic daytime BP ratio ≤0.9); nondippers were those whose
hypertension, were currently pregnant, or had chronic nocturnal BP declines less than 10% compared with the
kidney insufficiency with a glomerular filtration rate level of their daytime BP (mean nighttime to daytime
less than 60 mL/min/1.73 m2 for 3 months or more, BP ratio >0.9); extreme dippers are those whose noctur-
irrespective of the cause. Aside from patients with any nal BP has an exaggerated decrease of BP that is greater
disease requiring anti-inflammatory medication, those than 15% compared with their daytime BP; reversed
with diabetes or any other endocrine disorders, such as dippers are those whose average nighttime BP is higher
hyperthyroidism or any associated severe comorbidities than their average daytime BP. The night to day ratio
or CV risk factors (eg, family history of CV diseases), was calculated by expressing the mean nighttime DBP
and women with obesity (body mass index ≥35) were as a percentage of the mean daytime DBP.19
excluded. A full history of each patient was taken, and
full physical examinations were performed. Severe PE Two-Dimensional Echocardiography
was defined as the presence of any of the following Transthoracic 2-dimensional (2D) echocardiography
parameters: (1) markedly elevated BP measurements was performed on all participants using a VIVID S5
(≥160 mm Hg systolic BP [SBP] or ≥110 mm Hg transducer (GE Medical Systems). Standard views were
diastolic BP [DBP]) measured at least 6 hours while acquired in the left lateral decubitus position.
the patient is relaxed and lying on a bed, (2) protein-
uria (≥5 g/24 h or ≥3+ on 2 random samples taken 4 Left ventricle end-systolic and end-diastolic volumes were
hours apart); or (3) detection of manifestations of the recorded in the apical 4- and 2-chamber views to calcu-
end-organ disease oliguria (<500 mL in 24 hours) after late ejection fraction (EF) derived from Simpson’s modi-
fied biplane method. The M-mode was applied to assess

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Sayed, et al Preeclampsia Beyond Pregnancy

LV cavity dimensions, wall motion, and thickness at the thus, they are expressed as mean (SD) and compared
level of the papillary muscle in the parasternal short- with a Student t test. Nominal data were expressed as
axis view. The LV internal dimension measurements frequency (percentage). The χ2 test was used to compare
in diastole included interventricular septum, posterior nominal data. Multivariate logistic regression analysis
wall, LV end-diastole, and LV end-systole dimension. was used to identify the predictors of nondipping and
Left ventricular diastolic parameters, including maxi- diastolic dysfunction in the study cohort. The diag-
mum elastance (Emax), maximum atrial filling (Amax), nostic accuracy of the initial SBP and DBP to identify
E/A ratio, E/e′ ratio, deceleration time, and isovolumet- nondippers and those with diastolic dysfunction was de-
ric relaxation time, were recorded using pulsed-wave termined using receiver operating characteristic curve
Doppler and TDI for the transmittal inflow in the api- analysis. The level of confidence was 95%, and P < .05
cal 4-chamber view. was considered significant.
Diastolic function was estimated according to the
recommendations of the European Association of
Echocardiography and the American Society of Echo- Results
cardiography. Left ventricular diastolic dysfunction This study initially surveyed 500 patients with PE who
is defined as impaired LV relaxation with or without were admitted while the study was conducted. Only 186
impaired restoring forces (and early diastolic suction), of them agreed to participate in this study. Moreover,
with higher LV chamber stiffness, which increase car- 52 of these patients were excluded because of a previous
diac filling pressures and decrease the mitral E/A ratio diagnosis of hypertension, and 6 others were excluded
and e′ velocity (pulsed-wave velocity across lateral or because of rheumatic heart disease with significant valve
septal mitral annulus).19 lesions. After obtaining Assiut University Review Board
Based on clinical data, the patients were divided accor- approval, 128 women who fulfilled the inclusion criteria
ding to PE severity (mild, moderate, and severe PE) and were enrolled. Based on 24-hour ABPM while 3 months
BP profile (dippers and nondippers). postpartum, 90 of 128 (70.3%) women studied were
dippers, whereas only 38 (29.7%) were nondippers.
Statistical Analysis
All statistical analyses were performed using the SPSS Baseline Patient Characteristics
Statistics version 20 (IBM). The Shapiro–Wilk test was The baseline characteristics of the studied patients are
used to assess the normality of continuous data. All con- shown in Table I. Dippers and nondippers had mean
tinuous variables in the study were normally distributed; (SD) ages of 27.97 (5.18) and 29.26 (5.10) years, re-

TABLE I. Baseline Characteristics of Patients (N = 128)

Characteristics Dippers (n = 90) Nondippers (n = 38) P valuea

Age, mean (SD), y 27.97 (5.18) 29.26 (5.10) .36
Nulliparity, No. (%) 22 (24.4) 8 (21) .43
Gestational age, mean (SD), wk 35.77 (3.24) 36.20 (2.88) .66
Mode of termination, No. (%) .73
Cesarean delivery 48 (53.3) 20 (52.6)
Vaginal delivery 42 (46.7) 18 (47.4)
History of preeclampsia, No. (%) 42 (46.7) 22 (73.3) .03
Severe preeclampsia, No. (%) 40 (44.4) 22 (73.3) .01
SBP, mean (SD), mm Hg 155.88 (19.80) 158.42 (16.07) .62
DBP, mean (SD), mm Hg 99.88 (15.82) 99.47 (11.65) .91

DBP, diastolic blood pressure; SBP, systolic blood pressure.

a
P < .05 was considered statistically significant.

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Sayed, et al Preeclampsia Beyond Pregnancy

spectively, with the mean (SD) ages of gestation at There was no significant difference in the diastolic pa-
termination being 35.77 (3.24) vs 36.20 (2.88) weeks, rameters, namely LV end-diastolic diameter, LV end-
respectively. We noticed that severe PE presented in systolic diameter, interventricular septum, posterior
40 of 90 (44.4%) and 22 of 38 (73.3%) dippers and wall as well as Emax, LV end-systolic volume, and LV
nondippers, respectively. In addition, nondippers had end-diastolic volume. Ejection fraction was observed
a higher frequency of previous PE diagnosis and severe between dippers and nondippers either by M-mode or
PE (P < .05). Simpson’s method (P > .05). Dippers had a significantly
higher E/A ratio, e′ septal, and e′ lateral and a signifi-
Echocardiographic Characteristics cantly lower Amax, E/e′ septal, E/e′ lateral, decelera-
tion time, isovolumetric relaxation time, and left atrial

TABLE II. Echocardiographic Characteristics in Both Groupsa

Echocardiographic characteristics Dippers (n = 90) Nondippers (n = 38) P valueb

Systolic function

EF, %

by M-mode measurement 62.33 (4.17) 61.89 (4.08) .69

by Simpson method 61.62 (4.20) 61.21 (4.41 .72

LV end-diastolic dimension, mm 43.60 (4.55) 43.21 (6.22) .87

LV end-systolic dimension, mm 28.84 (3.78) 29.05 (4.52) .85

LV end-diastolic volume, mL 78.62 (14.39) 80.42 (18.78) .67

LV end-systolic volume, mL 29.84 (5.71) 30.42 (4.27) .69

Interventricular septum dimension in diastole, mm 9.01 (1.31) 9.63 (1.25) .08

Posterior wall dimension in diastole, mm 9.31 (1.32) 9.31 (0.88) .98

Diastolic function

Emax, mL/s 0.86 (0.15) 0.76 (0.29) .07

Amax, mL/s 0.56 (0.14) 0.82 (0.24) <.001

E/A ratio 1.58 (0.25) 0.99 (0.50) <.001

e′ lateral, m/s 0.16 (0.02) 0.10 (0.03) <.001

e′ septal, m/s 0.12 (0.02) 0.08 (0.03) <.001

E/e′ lateral, m/s 5.28 (0.98) 7.54 (2.64) <.001

E/e′ septal, m/s 6.87 (1.36) 9.74 (3.54) <.001

Deceleration time, ms 152.86 (14.88) 211.47 (45.04) <.001

Isovolumetric relaxation time, ms 65.75 (8.93) 102.36 (28.26) <.001

Left atrium volume, mL/m2 15.33 (1.81) 22.84 (5.37) <.001

Diastolic dysfunction, No. (%) 0 28 (73.7) <.001

A, mitral late diastolic velocity because of atrial contraction; Amax, maximum atrial filling; E, mitral early diastolic velocity; e′, pulsed-
wave velocity across lateral or septal mitral annulus; EF, ejection fraction; Emax, maximum elastance; LV, left ventricle.
a
Data are expressed as mean (SD), unless otherwise indicated.
b
P < .05 was considered statistically significant.

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Sayed, et al Preeclampsia Beyond Pregnancy

volume than those of nondippers (P < .001). Diastolic (35.5% vs 24.2%; P = .02) and were more likely to have
dysfunction was present in 28 (73.7%) nondippers and diastolic dysfunction (29% vs 15%; P = .01) than were
none of the dippers (P < .001; Table II). those with mild to moderate PE (Table IV).

Dipping Profile in the Studied Groups Assessment of Diastolic Dysfunction

The total average SBP and DBP and the night average as Among the women studied, 28 (21.9%) had diastolic
well as day/night BP reduction were significantly lower dysfunction, whereas 100 (78.1%) had no diastolic dys-
in dippers than in nondippers (P < .001). Daytime DBP function. Furthermore, no significant differences in
showed a tendency to be higher in dippers (mean [SD], DBP, SBP, or gestational age were observed among the
79.52 [6.96] vs 78.02 [6.31] mm Hg); however, this dif- groups, whereas all women with diastolic dysfunction
ference was not statistically significant (Table III). were nondippers (diastolic dysfunction was present in
28 nondippers [73.7%]). Of the women who had no
Effect of PE Severity diastolic dysfunction, none were nondippers (Table V).
A total of 62 (48.4%) women included in the study had
severe PE, whereas the remaining 66 women (51.6%) had Predictors of Nondipping
mild to moderate PE. Moreover, no significant differences Logistic regression analysis revealed that severe PE
in EF were observed between the groups. Nevertheless, (OR, 1.08; 95% CI, 1.05-10.56; P < .001) and recur-
women with severe PE were more frequently nondippers rent PE (OR, 1.36; 95% CI, 1.30-4.26; P < .001) were

TABLE III. Dipper Profiles in Studied Groups

BP profile Dippers, mean (SD), mm Hg (n = 90) Nondippers, mean (SD), mm Hg (n = 38) P valuea

Total average
<.001
Systolic 119.72 (7.06) 126.55 (5.66)
<.001
Diastolic 72.44 (6.17) 76.81 (5.57)

Day average
Systolic 129.06 (6.61) 129.94 (6.22) .26
Diastolic 78.02 (6.31) 79.52 (6.96) .40

Night average
Systolic 110.64 (7.45) 123.15 (5.95) <.001
Diastolic 67.06 (6.46) 74.10 (4.96) <.001

Day/night reduction
Systolic reduction 14.29 (3.29) 5.15 (3.29) <.001
Diastolic reduction 14.04 (3.87) 6.41 (2.97) <.001

BP, blood pressure.

a
P < .05 was considered statistically significant.

TABLE IV. Echocardiographic Findings Based on Severity of Preeclampsia

Variables Mild to moderate preeclampsia (n = 66) Severe preeclampsia (n = 62) P valuea

Ejection fraction, mean (SD), %

By M-mode measurements 119.72 (7.06) 126.55 (5.66) <.001

By Simpson method 72.44 (6.17) 76.81 (5.57) <.001
Diastolic dysfunction, No. (%) 10 (15) 18 (29) .01
Nondippers, No. (%) 16 (24.2) 22 (35.5) .02

a
P < .05 was considered statistically significant.

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Sayed, et al Preeclampsia Beyond Pregnancy

TABLE V. Blood Pressure, Dipper Profile, and Gestational Age Based on the Development of Diastolic
Dysfunction

Variables Diastolic dysfunction (n = 28) No diastolic dysfunction (n = 100) P valuea

Blood pressure, mean (SD), mm Hg

SBP 162.85 (16.01) 154.90 (19.15) .66

DBP 101.42 (12.92) 99.30 (15.15) .16
Gestational age, mean (SD), wk 36.25 (3.25) 35.79 (3.11) .63
Nondippers, No. (%) 28 (100) 0 <.001
DBP, diastolic blood pressure; SBP, systolic blood pressure.
a
P < .05 was considered statistically significant.

TABLE VI. Predictors of Nondipper Status

Variables Odds ratio 95% CI P valuea

Age, y 0.95 0.75-1.21 .71
Nulliparity 0.45 0.40-1.04 .99
Gestation age, wk 0.81 0.57-1.16 .26
Recurrent preeclampsia 1.36 1.30-4.26 <.001
Severe preeclampsia 1.08 1.05-10.56 <.001
b
Basic blood pressure, mm Hg 0.88 0.72-1.08 .25
a
P < .05 was considered statistically significant.
b
Basic blood pressure is the woman’s blood pressure in the evaluation setting 3 months after preeclampsia condition.

predictors for nondipping in such patients (Table VI). Discussion

We found that an initial SBP cutoff level of more than
150 mm Hg had a sensitivity and specificity of 54.2% The hemodynamic changes associated with PE mainly
and 64.4%, respectively, for predicting nondipping, result from endothelial dysfunction and increased the
with an area under the curve (AUC) of 0.59 (P = .01). sensitivity of blood vessels to angiotensin II, leading to
A DBP cutoff level of more than 90 mm Hg had a peripheral vasoconstriction and increasing total vascular
sensitivity and specificity of 68.4% and 44.4%, respec- resistance.20-22
tively, for predicting nondipping, with an AUC of 0.53 Although the office BP may return to its normal values
(P = .03). in the postpartum period, there are no sufficient data
regarding the reversibility of the BP pattern after de-
Predictors of Diastolic Dysfunction livery among patients with a history of PE. Therefore,
The findings showed that severe PE, previous PE, non- a history of PE is still considered a risk factor for CV
dipping, average nighttime DBP, and DBP night reduc- events later in life.4,23
tion were predictors for diastolic dysfunction (P < .05; The current study attempted to investigate the circadian
Table VII). An initial SBP cutoff level of more than BP pattern and explore its association with subclinical
140 mm Hg had a sensitivity and specificity of CV effects using 2D echocardiography in women with
100% and 32%, respectively, for predicting diastolic PE 3 months postpartum. The findings showed a posi-
dysfunction, with an AUC of 0.69 (P < .001). In addi- tive relationship between PE and a nondipping profile.
tion, we found that DBP at a cutoff level of more than Moreover, we compared the dipping profiles among
95 mm Hg had a sensitivity and specificity of 71.7% those with mild to moderate and severe PE. Accord-
and 50%, respectively, for predicting diastolic dysfunc- ingly, we found that circadian rhythm abnormality (ie,
tion, with an AUC of 0.60 (P < .001). blunted nocturnal dipping profile) was more frequent
among those with previously documented severe PE
than among those with a previous diagnosis of mild to

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Sayed, et al Preeclampsia Beyond Pregnancy

TABLE VII. Predictors of Diastolic Dysfunction

Variables Odds ratio 95% CI P valuea

Previous preeclampsia 1.23 1.22-2.22 .03
Severe preeclampsia 1.55 1.11-2.20 .01
Nondipping 3.43 1.99-5.56 <.001
Average nighttime DBP, mm Hg 1.61 1.24-3.94 <.001
DBP night reduction, mm Hg 1.70 1.11-2.73 <.001

DBP, diastolic blood pressure.

a
P < .05 was considered statistically significant.

moderate PE. Moreover, a blunted nocturnal BP pro- tive response mechanisms to reduced LV wall stress and
file was more prevalent in the women with recurrent maintenance of normal LV contractility, which could
PE. Similarly, Ditisheim et al24 described a positive as- promote equilibrium between myocardial oxygen supply
sociation between PE and a nondipping profile. The and demand. Among these mechanisms are increased
postpartum persistence of high levels of angiotensin II,25 LV mass and even LV hypertrophy,34-36 which have been
abnormal nitric oxide synthesis and metabolism,26 and found in a portion of patients with severe PE.37,38
the altered systemic vascular, which may persist for a Left ventricular concentric hypertrophy is known to
prolonged period,27,28 are the main mechanisms that in- be accompanied by subendocardial fibrosis. Duman et
duce abnormal circadian rhythm in PE. al39 described the coexistence of longitudinal myofibril
Studies have established that nocturnal hypertension dysfunction, which is mainly distributed in the suben-
exacerbates the endothelial damage in PE.29 Evidence docardium of patients with PE. This implies subendo-
has also found that the deterioration of maternal cardial ischemia and damage, which was validated by
hemodynamics is more common among pregnant the autopsy findings of severe PE with adverse outcomes
women with hypertension and nondipping BP pat- in Duman et al’s study.39
terns.30 The fast reduction in the LV pressure at the Therefore, 2D ventricular EF was used to examine sys-
end of systole and early diastole is an energy-dependent tolic function in the study cohort. Surprisingly, no pat-
process. That is what makes the process of myocardial hological reduction in LVEF was found in either mild
relaxation vulnerable in relation to various CV disor- to moderate or severe PE during the postpartum period.
ders.12,31 Moreover, we detected that an increase in the
afterload was associated with an increase in the LV Studies have shown that there are 3 types of myofibril
mass, both of which were associated with an increase in arrangement in the LV, mainly longitudinal and oblique
the LV filling pressure, a reduction in LV compliance, in the subendocardial and subepicardial layers and cir-
and diastolic dysfunction in patients with PE.32 cumferential between the layers. Contraction of the
longitudinal and oblique myofibrils occurs at the early
Analysis of diastolic function using TDI in this cohort systole, followed by contraction of the circumferential
revealed that abnormal hemodynamic alterations in- myofibrils responsible for the LV ejection. The suben-
duced a reversal in myocardial remodeling, which was docardial fibers are more vulnerable to the effects of
more frequently observed among nondippers. These ischemia and/or pressure load.40
findings show that most of the women with a nondip-
ping profile had diastolic dysfunction, an issue that was Standard parameters to estimate LV contractility, such
not observed among dippers. as EF, are volume- and heart rate–dependent.41,42 Both
are increased as compensatory hemodynamic changes
Diastolic dysfunction is generally antecedent to systolic during pregnancy.20,22 This could explain the preserved
dysfunction in the context of hypertensive or ischemic EF in this study’s cohort.
heart diseases and carries prognostic value in the predic-
tion of long-term CV morbidity.33 According to Frank Tyldum et al43 and Tatapudi et al44 also reported pre-
Starling and Laplace laws, both elevated after load and served LVEF in women with PE. Interestingly, Ilic et
peripheral vascular resistance are associated with adap- al30 and Valensise et al45 reported systolic dysfunction

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Sayed, et al Preeclampsia Beyond Pregnancy

and reduced EF among nondippers, which were absent Recommendations

among dippers. However, they studied pregnant women We recommend the analysis of echocardiographic find-
without proteinuria who had gestational hypertension ings before pregnancy with a simultaneous evaluation
and a higher average BP value than that of the patients of the longitudinal LV systolic function using strain
in this study. rate imaging and longer follow-up times to determine
Uno et al46 also found cardiac remodeling concerning whether diastolic dysfunction and nondipping status are
LV end-diastolic and end-systolic dimensions among predictors of sustained hypertension in this cohort. This
patients with PE, although the EF was still preserved. would certainly guide prevention and intervention strat-
These changes were more prominent in those with se- egies for patients with PE and reduce the risk of heart
vere PE than in those with mild PE and were not re- failure and other future CV morbidities in subsequent
versed completely 1 month after delivery. pregnancies and among younger mothers.
Recent studies estimating the longitudinal LV systolic
function using 2D speckle-tracking echocardiography Published: 22 May 2023
have found that the global strain value in women with Conflict of Interest/Disclosures: None
severe PE had decreased, which indicates LV systolic Funding/Support: None
dysfunction in women with severe PE.47,48 In additi-
Author Contributions: M.S. performed examinations of the pa-
on, severe and recurrent PE were noted as significant tients clinically and with echocardiography to verify the selection
predictors for both a nondipping profile and diastolic criteria, evaluated statistics, and wrote the main text (main au-
dysfunction. Valensise et al45 detected that cardiac dy- thor). M.R. was responsible for patient recruitment, data analysis
sfunction in the nonpregnant state was more frequent (ABPM) and documentation, organization of the follow-up visits,
among patients with recurrent PE. However, Tatapudi patient contact, and statistics. A.M.A. was responsible for patient
recruitment and for all obstetrics-related issues. A.Y. contributed
et al44 detected that cardiac dysfunction was more pro- to the writing (introduction) and data documentation. M.A.G.
minent among those with severe PE. examined the patients using echocardiography and handled logis-
tics and administrative issues to support the study and facilitate
Limitations the steps of recruitment and follow-up procedures.

The main limitation of this study was the relatively Additional Information: The abstract was accepted to be
published as an e-Poster in the session entitled “Cardiovascular
small sample-size population in a single-center experi-
Disease in Special Populations,” ESC Congress 2020 - The Digi-
ence with all inherited constraints on which the results tal Experience. The abstract was available online from Saturday,
are based. This leads to higher variance and increases August 29, 2020, until Tuesday, September 1, 2020.
the potential for bias. In addition, the contribution
of healthy pregnant women to the prospective cohort
study was, for some participants, not convenient, which References
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