# Identification of Early HFpEF after Preeclampsia by Exercise Stress Testing

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2024 · $869,696

## Abstract

ABSTRACT
Pregnancy is a unique, early moment of cardiovascular stress in young women that may “unmask”
cardiovascular disease (CVD) propensity. Preeclampsia (PreE)—characterized by new-onset hypertension and
proteinuria—has been linked to left ventricular diastolic dysfunction that may persist for years post-partum, and
an increased risk of developing heart failure with preserved ejection fraction (HFpEF) over the decade following
pregnancy. It is unclear if PreE simply represents a failed stress test or directly contributes to the pathophysiology
of future CVD. Women and minorities are traditionally understudied in HFpEF, despite their disproportionate risk.
This is the first large prospective study to investigate the hypothesis that PreE leads to persistent functional,
hemodynamic, structural and biochemical cardiovascular changes that mirror early HFpEF. By defining the echo,
proteomic and hemodynamic risk profile for early HFpEF, this will afford the opportunity for future studies to
mitigate disease through pharmacologic/lifestyle interventions in a targeted population. We hypothesize that
persistent structural-functional myocardial alterations in women with PreE are linked to pre- and post-gravid
cardiometabolic risk factors and functional capacity and select pathways of vascular and inflammatory stress
central to HF risk. We will use perturbational hemodynamic studies to elaborate myocardial phentoypes defining
of HFpEF in women with PreE. We address our central hypothesis in 3 Specific Aims (SA): SA1: To measure
relation between post-partum subclinical LVDD and pregnancy-specific risk factors in 250 women with PreE and
250 normotensive women (25% Black) through rest and provocation echocardiographic imaging, SA2: To
quantify the hemodynamic consequences of early persistent LVDD in women with PreE, SA3: To identify
differences in cardiovascular pathways of vascular remodeling and inflammation and their association with
subclinical myocardial dysfunction in women with PreE. For this study, we will leverage the infrastructure of our
NIH funded multidisciplinary cardio-obstetrics clinical research team for recruitment, retention, and risk factor
modification (U01HG013189, R21NR020857). A fundamental strength of this proposal is the ESI PI’s experience
in recruiting and retaining women at this critical stage in CV development. Our targeted enrollment of Black
women addresses clinical and investigative gaps in this population at high short and long-term CV risk following
a preeclamptic pregnancy. Successful completion of these studies in a large group of women across race will
define high-risk PreE-linked structural/functional changes to support risk stratification and future interventional
studies at this critical moment in CVD development in women.

## Key facts

- **NIH application ID:** 10978719
- **Project number:** 1R01HL170020-01A1
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Kathryn Lindley
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $869,696
- **Award type:** 1
- **Project period:** 2024-08-20 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10978719

## Citation

> US National Institutes of Health, RePORTER application 10978719, Identification of Early HFpEF after Preeclampsia by Exercise Stress Testing (1R01HL170020-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10978719. Licensed CC0.

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