Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy.

Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42 +/- 5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9 +/- 7.1 versus 46.0 +/- 6.5 g/m(2); P=0.001) and ejection fraction (65.6 +/- 5.4% versus 63.7 +/- 4.3%; P=0.03) but lower global longitudinal strain (-18.31 +/- 4.46% versus -19.94 +/- 3.59%; P=0.02). Left atrial volume index was also increased (40.4 +/- 9.2 versus 37.3 +/- 7.3 mL/m(2); P=0.03) and E:A reduced (1.34 +/- 0.35 versus 1.52 +/- 0.45; P=0.003). Aortic compliance (0.240 +/- 0.053 versus 0.258 +/- 0.063; P=0.046) and functional capillary density (105.4 +/- 23.0 versus 115.2 +/- 20.9 capillaries/mm(2); P=0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure (P<0.01, P=0.01, and P=0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.