ABSTRACT Objectives After pre‐eclampsia (PE), the prevalence of structural heart disease without symptoms, i.e. heart failure Stage B (HF‐B), may be as high as one in four women in the first year postpartum. We hypothesize that a significant number of formerly pre‐eclamptic women with HF‐B postpartum are still in their resolving period and will not have HF‐B during follow‐up. Methods In this prospective longitudinal cohort study, we included 69 formerly pre‐eclamptic women who underwent serial echocardiographic measurements at 1 and 4 years postpartum. HF‐B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m2), concentric remodeling (relative wall thickness > 0.42 and LVMi ≤ 95 g/m2), mild systolic dysfunction (left ventricular ejection fraction > 40% and < 55%) or asymptomatic valvular disease. Women were subdivided and analyzed according to HF‐B outcome: no HF‐B at either visit; HF‐B at first visit only; HF‐B at second visit only; HF‐B at both visits. Results The prevalence of HF‐B in formerly pre‐eclamptic women was 23% in the first year postpartum and 23% after 4 years. At the second visit, HF‐B had resolved in 62.5% of affected women but was newly developed in 19% of initially unaffected women. At the first visit, 56% of women diagnosed with HF‐B had reduced systolic function whereas at the second visit 69% of women with HF‐B had concentric remodeling with mostly normal ejection fraction, consistent with diastolic dysfunction. Conclusions The prevalence of HF‐B can be considered consistently high (1 in 4) amongst formerly pre‐eclamptic women at follow‐up. Nonetheless, at an individual level, more than 60% of women found initially to be affected by HF‐B will recover, whilst about 20% of formerly pre‐eclamptic women with normal echocardiography in the first year postpartum will develop HF‐B over the following years. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.