study is to assess cardiac function/remodelling at mid-gestation in normotensive women, some of whom subsequently developed PE. Methods: This was a prospective study on 351 women assessed at 20-23 weeks gestation. In particular, women at increased risk of developing PE (127 with high resistance uterine artery Doppler indices and 79 with PE in a previous pregnancy) were recruited. Women underwent blood pressure profiling, echocardiography, cardiac tissue Doppler and strain rate analysis. Results: PE subsequently developed in 53 women (22 preterm, 31 at term). Five (23%) of women who developed preterm PE exhibited evidence of global diastolic and/or systolic dysfunction as well as left ventricular remodelling at midgestation. These features were not evident in women who subsequently developed term PE or had a normal pregnancy outcome (p < 0.0001). Conclusions: This study demonstrates that impaired cardiac function and remodelling precede the onset of preterm PE by several weeks in a quarter of cases. The majority of women who develop preterm PE and all women who develop term PE have normal global cardiac function and geometry at mid-gestation. Women with mid-gestation abnormal cardiac findings may have preexisting myocardial dysfunction. These cardiac findings may be useful in screening for the onset of preterm PE and may persist in the postnatal period influencing the long-term cardiovascular outlook.