Midlife Left Ventricular Remodeling among Individuals with a History of Preeclampsia With and Without Current Hypertension

Background: Individuals with a history of preeclampsia (PEC) are at higher risk for the development of hypertension (HTN) and cardiovascular disease. The impact of PEC and HTN on measures of left ventricular (LV) remodeling and LV myocardial composition has not been well studied. This study aims to phenotype LV structure and myocardial characteristics among subgroups with and without a history of PEC and current HTN.

Methods: We recruited pre-menopausal women with an index pregnancy between the years of 2008-2014 without pre-pregnancy HTN or pre-pregnancy diabetes currently at 10 to 15 years postpartum. Participants had a study visit with blood pressure measurement and underwent cardiac MRI utilizing a Siemens Sola 1.5 Tesla scanner with standard imaging. We obtained late gadolinium-enhancement imaging 10 minutes after a 0.2 mmol/kg intravenous bolus of gadoteridol with phase-sensitive inversion recovery reconstruction. Using Modified Look Locker Inversion (MOLLI) recovery sequences, we measured diffuse interstitial fibrosis (extracellular volume). We calculated cardiomyocyte volume as LV mass*[100%-ECV%]). HTN was defined as blood pressure >130/80 mmHg or on antihypertensive medications. Analyses were performed by subgroups +/- HTN and +/- PEC using ANOVA and chi² or Fisher’s Exact tests.

Results: Among 73 participants who completed a cardiac MRI (mean age 42 years, 30% self-identified Black race), 7 had -HTN/-PEC, 18 had -HTN/+PEC, 19 had +HTN/-PEC, and 21 had +HTN/+PEC. Subgroups with and without HTN/PEC differed in measures of LV remodeling including interventricular septal (IVS) wall thickness (p< 0.001), posterior wall (PW) thickness (p=0.007), and relative wall thickness (RWT) (p=0.012) (Table). Specifically, looking between subgroups, those with +HTN/+PEC had thicker IVS vs -HTN/-PEC (10 vs 7 mm; p< 0.001) and vs -HTN/+PEC (10 vs 9 mm; p=0.029), thicker PW vs -HTN/-PEC (9 vs 6 mm; p=0.004), and higher RWT vs -HTN/-PEC (0.37 vs 0.27; p=0.008). Those with +HTN/-PEC had thicker IVS vs -HTN/-PEC (10 vs 7; p=0.005). Interestingly, those with -HTN /+PEC had thicker PW (9 vs 6; p=0.017) and higher RWT (0.35 vs 0.27; p=0.048) vs -HTN/-PEC. Cardiomyocyte volume was higher among those with HTN, although not statistically significantly different. There was no difference in diffuse interstitial myocardial fibrosis (extracellular volume) between groups. Qualitative evidence of late gadolinium enhancement was rare (n=4) and was only present among those with HTN.

Conclusion: In this cohort of premenopausal women, having HTN or a history of PEC was associated with more adverse measures of LV remodeling, greatest among those with PEC history who develop HTN. Cardiac MRI distinguished that LV remodeling may be driven more by cardiomyocyte hypertrophy than fibrosis among those with PEC history who develop HTN. Future studies should investigate best strategies to mitigate LV remodeling for midlife women with HTN, especially those with a history of PEC.

Clinical and Cardiac MRI measures by subgroups with and without current hypertension and preeclampsia history