Objectives Preeclampsia (PE) is characterised by cardiac remodelling and biventricular diastolic dysfunction. Preterm but not term PE, is also associated with severe left ventricular hypertrophy and biventricular systolic dysfunction. It is not known if these cardiac findings precede the onset of signs and symptoms of PE. The aim of this study is to assess cardiac remodelling and function at mid-gestation in normotensive, nulliparous women, some of whom subsequently developed PE.

Methods This was a prospective study on 213 women, including 152 at increased risk of developing PE as determined by mid-gestational uterine artery Doppler assessment. Women underwent blood pressure profiling, echocardiography and cardiac tissue Doppler analysis at 20-23 weeks' gestation.

Results PE subsequently developed in 46 of the 213 women: 18 preterm and 28 at term. Women who subsequently developed PE had evidence of left ventricular concentric remodelling (15/46, 33%) which was not found in the controls (p<0.0001). Only women who developed preterm PE exhibited a high resistance-low volume (high TVRI-low CI) hemodynamic state at mid-gestation. The latter group also had evidence of left ventricular diastolic and/or systolic dysfunction (33%) and segmental impaired myocardial relaxation (72%).

Conclusions Maternal cardiac remodelling precedes the onset of PE by several weeks 30% of women. Overt maternal cardiac dysfunction is evident at mid-gestation only in women who subsequently develop preterm, not term PE. Although it is not possible to distinguish pre-existing cardiac dysfunction from that acquired as a result of pregnancy, these cardiac findings may be useful in screening for the onset of preterm PE.