Perspective:

A portion of women with pre-eclampsia with severe features develop clinically apparent pulmonary edema, often occurring in the early post-partum period in the setting of hemodynamic changes and fluid resorption. Previously, these women were presumed to have some degree of diastolic dysfunction. This study illustrates the differences in echocardiographic parameters among women with severe pre-eclampsia, thus confirming that cardiac dysfunction does occur in this setting. These women are sometimes reassured as long as the left ventricular systolic function is normal, thus ruling out peripartum cardiomyopathy; however, the long-term implications of diastolic dysfunction in the setting of pre-eclampsia are unknown. Pre-eclampsia is associated with an increased future risk of cardiovascular disease. Whether aggressive risk factor modification can modify or reduce this long-term risk remains to be studied. Further studies could assess the duration of these echocardiographic changes with serial measurements and examine the effects of risk factor modification.