Abstract Body (Do not enter title and authors here): Introduction
Preeclampsia, a pregnancy-specific complication, is an established risk factor for long-term cardiovascular complications, including heart failure with preserved ejection fraction (HFpEF), however, the exact mechanism of this cardiovascular dysfunction remains unclear. This study aimed to characterize the cardiac structure and myocardial tissue using cardiac magnetic resonance imaging (CMR) in women with a long-term history of preeclampsia. We hypothesized that prior preeclampsia is associated with myocardial fibrosis or scarring.

Methods
Women with singleton pregnancies delivered between 2004 and 2019 were identified and prospectively enrolled to undergo CMR (1.5T Signa Artist GE HealthCare) with cine imaging, tissue multiparametric quantitative mapping and late gadolinium enhancement (LGE) imaging.

Results
Twenty-three subjects (41.0±6 years, 12.7±5 years post-partum) were included. Women with a history of preeclampsia (n=11) were compared to a healthy control group of women with prior normotensive, uncomplicated pregnancy (n=12). There was no significant difference in LV systolic function, LV mass, T1 and T2 mapping, or LGE between the preeclamptic group versus controls, although right ventricular (RV) systolic function was significantly higher (65±7.5% vs 58±7.7%; p=0.04) in individuals with preeclampsia (Panel A). Notably, global extracellular volume fraction (ECV) was significantly higher in women with preeclampsia versus normotensive pregnancies (47.2±21.2% vs 31.0±4.8% respectively; p=0.02) (Panel B).

Conclusions
Global myocardial ECV appears to be increased with preeclampsia, many years after the index pregnancy, potentially reflecting diffuse interstitial fibrosis. Diffuse fibrosis may stiffen the myocardium and reduce myocardial compliance, resulting in loss of diastolic function. Further research is needed to determine whether these alterations in cardiac structure and increased myocardial fibrosis contribute to preeclampsia-associated HFpEF and cardiovascular outcomes.