ObjectivesSystemic sclerosis (SSc) is associated with subclinical cardiac involvement often missed by conventional echocardiography. The right ventricular myocardial performance index (RV MPI), a Doppler-derived composite of systolic and diastolic function, has been proposed as an early marker of right ventricular (RV) dysfunction. This study was conducted to compare RV MPI between SSc patients and healthy controls and to determine its association with clinical and functional features of SSc.MethodsA cross-sectional study was performed in 60 patients with SSc and 83 age-matched healthy controls, all women. Comprehensive transthoracic echocardiography, including pulsed-wave Doppler of RV inflow and outflow, was used to calculate RV MPI as (IVCT + IVRT)/ET. Tricuspid annular plane systolic excursion (TAPSE) and the TAPSE/systolic pulmonary artery pressure (TAPSE/sPAP) ratio were recorded, together with disease duration, modified Rodnan skin score (mRSS) and pulmonary function tests (FVC, DLCO). Group comparisons and correlation analyses were conducted, and multivariable logistic regression and receiver operating characteristic (ROC) analyses were applied.ResultsLeft ventricular ejection fraction was similar between groups (median 60% vs. 61%), whereas RV MPI was found to be significantly higher in SSc than in controls (median 0.54 vs. 0.35, p < 0.001). Higher pulmonary artery systolic pressure, lower TAPSE and a reduced TAPSE/sPAP ratio were also observed in SSc (all p < 0.001). After adjustment for age and TAPSE/sPAP, RV MPI remained independently associated with SSc status. ROC analysis demonstrated excellent discrimination for SSc by RV MPI (area under the curve 0.92; threshold 0.47; sensitivity 78%, specificity 94%), whereas. TAPSE/sPAP showed only moderate discrimination. RV MPI was not significantly correlated with CRP, FVC, DLCO, mRSS or disease duration. In patients with interstitial lung disease, higher MPI values and more frequent DLCO < 80% were detected.ConclusionRV MPI was shown to be significantly increased in SSc, even in the absence of overt cardiac symptoms or reduced left ventricular ejection fraction and remained independently associated with SSc. Together with reduced TAPSE and TAPSE/sPAP ratios, these findings indicate impaired RV–pulmonary arterial coupling. RV MPI therefore appears to be a simple and sensitive non-invasive parameter for the identification of cardiac involvement in SSc.

Associations between mental health disorder symptoms and cardiac function among Royal Canadian Mounted police cadets during the Cadet training program.

This study aimed to evaluate the modified myocardial performance index (MPI) in fetuses of mothers with pregestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM) and to assess its relationship with adverse perinatal outcomes. This case-control study included 157 singleton pregnancies divided into three groups: pregestational DM (n = 17), GDM (n = 52), and controls (n = 88). Fetal echocardiography was used to measure modified MPI, isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), and mitral E/A. Neonatal outcomes, including neonatal intensive care unit (NICU) admission and respiratory distress syndrome (RDS), were recorded. Statistical analyses were performed using appropriate tests. Fetuses of diabetic mothers had significantly higher modified MPI and ICT values compared to controls (p = 0.007, p < 0.001 and p = 0.003, p < 0.001). NICU admission and RDS rates were also more frequent in pregnancies complicated by pregestational diabetes (p = 0.002 and p = 0.001, respectively). However, modified MPI was not associated with NICU admission or RDS (p > 0.05). Elevated modified MPI and ICT in diabetic pregnancies may reflect subclinical fetal cardiac dysfunction, although they do not predict short-term adverse neonatal outcomes. Further prospective research is needed to establish the clinical utility of fetal modified MPI for risk stratification in diabetic pregnancies.

Prognostic value of fetal left ventricular myocardial performance index for mortality or ECMO in congenital diaphragmatic hernia.

AimThe aim of this study was to evaluate left ventricular function in hypoxic neonates undergoing therapeutic hypothermia using echocardiography.Materials and methodsThis multicenter, prospective, case-control, observational study involved 113 neonates, including 55 in the hypothermic group and 58 nonhypothermic controls. Echocardiographic measurements were taken by two neonatologist (NB and RB) during therapeutic hypothermia and after rewarming using various techniques.ResultsThere was a significant difference between the study group and controls in mean blood pressure (p <0.001) and heart rate (p = 0.004) during therapeutic hypothermia. Significantly higher post-rewarming heart rate was observed in the study group compared to controls (p <0.001). Significantly lower mean A-wave (A mv) (p = 0.04) and E-wave (E mv) (p = 0.003) mitral valve velocities, as well as reduced mitral annular plane systolic excursion (p <0.001), cardiac output (p <0.001), and left ventricular internal diameter in diastole (p <0.001) were observed in the study group compared to controls during therapeutic hypothermia. The mean left ventricular myocardial performance index was significantly higher in the study group (p = 0.006). Tissue Doppler imaging showed significantly lower left ventricular E’ velocity (p <0.001) and E’/A’ ratio during therapeutic hypothermia in the study group compared to controls. Left ventricular A’ (p = 0.006), E’ (p <0.001), and S’ (p = 0.003) velocities were significantly lower, while myocardial performance index (p <0.001) was significantly higher in the study group during therapeutic hypothermia than after rewarming.ConclusionsHypothermic neonates exhibit more severe global impairment compared to healthy controls. This is reflected in higher myocardial performance index values and lower E’/A’ ratio, which indicates diastolic dysfunction.

Indomethacin is one of the most effective and widely used tocolytic agents for treating threatened preterm labor and prolonging pregnancy. Nonetheless, data on its fetal effects, particularly regarding cardiac functions, remain limited. The primary aim of this study was to evaluate the effects of indomethacin treatment on fetal cardiac structures, the modified myocardial performance index (Mod-MPI), and hemodynamic parameters to establish evidence-based monitoring recommendations in cases of threatened preterm labor. In this prospective study of 114 pregnant women, 57 cases diagnosed with threatened preterm birth received indomethacin tocolytic therapy, while 57 controls had uneventful pregnancies. Demographic characteristics, perinatal outcomes, Doppler measurements, cardiac structural measurements, Mod-MPI, and tricuspid regurgitation were compared between groups. Doppler analysis revealed no significant differences except for umbilical artery pulsatility index, which was elevated in the indomethacin group (0.941 ± 0.160 vs. 0.869 ± 0.171, p = 0.023) due to vasoconstrictive effects from prostaglandin synthesis inhibition. Isovolumetric contraction and relaxation times were lower in the indomethacin group (42.3 ± 0.5 vs. 47.2 ± 2.7, p = 0.020; 49.3 ± 1.9 vs. 48.2 ± 1.8, p = 0.030). However, Mod-MPI did not differ significantly between the groups (0.464 ± 0.11 vs. 0.44 ± 0.09, p = 0.349). Although tricuspid regurgitation was observed in 14 of 57 fetuses (24.6%) exposed to indomethacin, perinatal outcomes were not significantly different. Indomethacin treatment does not negatively affect fetal cardiac function or Mod-MPI. When tricuspid regurgitation occurs, increased monitoring is recommended rather than treatment cessation if other parameters remain stable.

Current models to predict outcomes in advanced twin-twin transfusion syndrome are limited. We hypothesized that twin and cotwin echocardiographic factors would improve model performance for donor and recipient demise following laser photocoagulation therapy. We performed a multicenter retrospective cohort study of stage 3 to 4 twin-twin transfusion syndrome referred for laser photocoagulation therapy. Fetal echocardiograms were analyzed at a core laboratory. We used multivariable logistic regression models to select variables used for generalized linear mixed-effects modeling. Separate models were developed for donor and recipient demise, using both twin and cotwin variables. Models were assessed by area under the receiver operating characteristic curves. Laser photocoagulation therapy was performed in 285 twin gestations at 20.2±2.8 weeks. Donor demise (32%) occurred more frequently than recipient demise (15%; P<0.001). Final model variables for donor demise were donor fetal weight, nifedipine administration, umbilical arterial and venous flow patterns, donor cardiac output, left ventricular myocardial performance index, recipient deepest vertical pocket, recipient chest/thoracic ratio, recipient cardiac output, and recipient ductus venosus flow pattern; and for recipient demise were nifedipine use, recipient combined cardiac output, recipient left ventricular myocardial performance index, recipient umbilical arterial flow pattern, and donor left ventricular myocardial performance index. Including cotwin variables in models for donor and recipient demise improved performance. Final model area under the receiver operating characteristic curves were 0.82 for both donor and recipient demise. This is the largest multicenter study to rigorously evaluate echocardiographic metrics associated with fetal demise in twin-twin transfusion syndrome and the first to identify intertwin parameters associated with cotwin demise.

Objectives: Chronic renal failure (CRF) represents a progressive and irreversible decline in renal function. Among individuals with end-stage renal disease (ESRD), cardiovascular disorders are recognized as the leading contributors to morbidity and mortality. The present study aimed to assess cardiac function in pediatric patients diagnosed with CRF. Methods: This cross-sectional study included 30 pediatric patients with CRF who were under follow-up between October 2018 and August 2019, along with 30 age- and sex-matched healthy controls. The CRF group was further divided into two subgroups according to dialysis status. For all participants, conventional 12-lead electrocardiography was performed, and indices associated with atrial (P-wave dispersion, Pd) and ventricular (QT dispersion, corrected QT dispersion, Tp–e, Tp–e/QT, Tp–e/QTc) arrhythmia risk were recorded. Each subject also underwent a detailed echocardiographic evaluation, including both conventional and tissue Doppler measurements. Results: Anthropometric characteristics and blood pressure values did not significantly differ between the patient and control groups. Apart from an increased mean corrected QT dispersion (QTcd), other electrocardiographic parameters were comparable between groups. Ejection fraction (EF) and fractional shortening (FS) values were lower in CRF patients compared with controls. LV mass index (LVMI) was significantly higher in the dialysis subgroup relative to the control group. Additionally, the myocardial performance index (Tei index) was markedly elevated in CRF patients (P&amp;lt;0.001). Conclusions: These findings underscore the need for comprehensive cardiac evaluation in children with CRF. Nonetheless, larger-scale studies are warranted to confirm and expand upon these observations.

Neonatal pulmonary hypertension (PH) is a major cause of illness and death in newborns. Neonatologist-performed echocardiography (NPE) is increasingly used as a bedside tool to assess heart function, shunt patterns, and pulmonary blood flow in real time, helping clinicians better understand the severity and type of PH. This narrative review summarizes current evidence on the use of NPE in diagnosing, monitoring, and treating neonatal PH, drawing on clinical studies, guidelines, and expert recommendations. NPE provides key diagnostic and therapeutic information, including evaluation of ventricular function, estimation of pulmonary pressures, and assessment of shunt direction. Advanced measures-such as tricuspid annular plane systolic excursion (TAPSE), myocardial performance index, pulmonary artery acceleration time (PAAT), and deformation imaging-improve accuracy and help guide therapies like inhaled nitric oxide, milrinone, and sildenafil. NPE is also useful in chronic conditions such as bronchopulmonary dysplasia (BPD)- and congenital diaphragmatic hernia (CDH)-associated PH. Despite its clear clinical value, NPE use remains limited by variations in training, protocols, and resource availability. Standardized curricula, accreditation, and unified reporting practices are needed to ensure safe, consistent integration of NPE into neonatal care pathways.

Although the influence of pacing on left ventricular function is well documented, the effect of right ventricular (RV) pacing, particularly concerning lead location (septal vs. apical), on RV function remains underexplored. Furthermore, there is a lack of literature regarding right atrial (RA) remodelling and functional changes following pacemaker implantation. To assess the effect of a dual-chamber pacemaker on RA and RV structure and function, and their correlation with the site of RV lead positioning using 4D echocardiography. This prospective study evaluated 22 patients undergoing permanent dual-chamber pacemaker implantation. Comprehensive clinical and transthoracic echocardiographic assessments were performed at three time points: pre-implantation, pre-discharge, and at the 3-month follow-up. RV function was quantified using tricuspid annular plane systolic excursion, myocardial performance index, global longitudinal strain, and 3D RV ejection fraction. RA function was assessed for reservoir, conduit, and contractile phases using strain analysis. All echocardiographic measurements were conducted by a single echocardiographer utilizing the 4D Vivid S70N system. Device programming parameters were recorded postoperatively. Although conventional parameters remained within the normal range, functionally, a decline in RA reservoir and conduit strain (p = 0.01 and p = 0.02, respectively) and RV GLS (p < 0.001) was observed. TR severity also worsened in nearly 40% of patients compared to baseline (p < 0.001). All patients had a pacing burden greater than 80%. RA and RV structural and functional changes begin within 3 months, irrespective of lead site, although non-septal sites exhibited a greater impairment.

Fully-automated fetal left ventricular myocardial performance index measurement in pulsed-wave Doppler ultrasound based on tubular structure enhancement and intensity projection waveform peak detection: A feasibility study

Background: Low-dose aspirin (ASA) is used in obstetrics for different indications, mainly to prevent preeclampsia. This study investigated the underlying mechanism of ASA’s effect on the fetus’s cardiovascular functions. Methods: 42 pregnant women at 18-24 weeks of gestation, identified as high-risk for preeclampsia, received 160 mg of ASA daily. Fetal Doppler ultrasound was performed before and three weeks after ASA treatment, assessing ductus venosus, middle cerebral, umbilical, and uterine arteries pulsatility indices as well as pulmonary, aorta, and superior vena cava (SVC) diameters in the three-vessel view, including pulmonary/aorta and SVC/aorta ratios. All analyses were performed using SPSS software version 27, with a significance threshold set at p&lt;0.05. A paired t-test was used to assess differences in means. The Chi-square and Fisher’s exact test analyzed nominal variables. Results: Post-intervention analysis revealed significant improvements in abnormal uterine artery resistance (p&lt;0.001) and abnormal pulsatility index of the umbilical artery, middle cerebral artery, and ductus venosus (p&lt;0.001 for all). Moreover, 160 mg/day aspirin administration significantly increased mitral E/A (early filling velocity/atrial contraction velocity: 0.397±0.029; p&lt;0.001), diameters of aorta (4.390±0.852; p&lt;0.001), pulmonary artery (4.895± 1.087; p&lt;0.001), and SVC (2.511±0.535; p&lt;0.001), while significantly decreasing left ventricular myocardial performance index (p&lt;0.05). Conclusion: Daily administration of 160 mg of aspirin enhances fetal vascular and cardiac function. Evaluating fetal cardiovascular parameters beyond routine uterine artery Doppler, especially in high-risk pregnancies, and initiating ASA therapy in cases of insidious abnormalities, may help delay or prevent fetal complications such as intrauterine growth restriction (IUGR) by improving cardiovascular function.

Background: Gestational diabetes mellitus (GDM) affects 6–12% of pregnancies globally and is linked to adverse fetal cardiac remodeling. Offspring exposed to GDM in utero show altered myocardial performance index (MPI) and increased left ventricular mass index (LVMI). We performed a systematic review and meta-analysis to assess the impact of maternal GDM on neonatal and early childhood cardiac structure and function. Methods: A PRISMA-compliant search was conducted across PubMed, Scopus, and Web of Science (last updated April 2024) for studies comparing echocardiographic parameters in GDM-exposed vs non-GDM-exposed offspring. Inclusion criteria: (1) human subjects, (2) reported MPI or LVMI, (3) GDM diagnosed per WHO/ADA criteria, and (4) echocardiography performed &lt;12 years of age. Pooled effect sizes were computed using a random-effects model (Hedges’ g). Heterogeneity assessed via I2, and subgroup analyses explored term vs preterm outcomes and GDM treatment status. Results: 13 studies (n = 1,621 offspring) met inclusion. GDM-exposed offspring had significantly higher LVMI (Hedges’ g = 0.51; 95% CI: 0.34–0.67) and abnormal MPI (Hedges’ g = 0.59; 95% CI: 0.43–0.75) compared to controls. The effect was most pronounced in third trimester GDM and insulin-treated cohorts. Heterogeneity was moderate (I = 48%). Subgroup analysis showed greater dysfunction in boys vs girls (p = 0.04). Meta-regression revealed stronger MPI alteration with increasing maternal HbA1c (β = 0.22, p = 0.003). No evidence of publication bias was observed. Conclusion: In utero exposure to maternal GDM is associated with early subclinical LV dysfunction and remodeling, reflected by elevated MPI and LVMI. These changes may predispose offspring to long-term cardiometabolic risk. Our findings support the utility of early echocardiographic screening in this population and the importance of optimized GDM management to prevent fetal cardiac programming.

Background: Obesity is associated with left atrial (LA) and left ventricular (LV) dysfunction, however, there is little information on when left heart structural and functional changes begin to appear. To clarify this, we assessed left heart geometry and function in obese healthy infants. Methods: Two-dimensional echocardiography was performed in 186 infants aged 4 months. Subjects were divided into 3 groups according to body mass index (BMI): normal (n= 110), &lt;18.0 kg/m 2 ; overweight (n=45), 18 to 19.9 kg/m 2 ; obesity (n=31), ≧20 kg/m 2 . LA volumes (maximum, minimum, and pre-atrial contraction) were measured using speckle tracking echocardiography. LA total emptying fraction, passive emptying fraction, and active emptying fraction were calculated. LV end-diastolic volume, ejection fraction, mass, and mass/volume ratio, mitral annular myocardial velocities during early (Em) and late diastole (Am), and myocardial performance index were assessed. Results: Results are shown in Table. Systolic blood pressure was significantly higher in the obesity group than in the normal and overweight groups. Compared with the normal groups, LA volumes (maximum, minimum, and pre-atrial contraction), LV end-diastolic volume, and LV mass were significantly higher in the overweigh group and the obesity group. LV mass/volume ratio as an index of LV hypertrophy was significantly greater in the the obesity group than those in the normal groups. Compared with the normal group, LA active emptying fraction as an index of LA pump function was significantly higher in the obesity group. Mitral annular myocardial velocity during late diastole in the obesity groups was significantly higher than that in the normal group. There were no significant differences in ejection fraction, mitral annular myocardial velocity during early diastole, myocardial velocity ratio (Em/Am), and myocardial performance index among the 3 groups. Conclusion: Infant obesity is associated with left heart chamber enlargement, LV hypertrophy, and increased LA pump function, which may be compensatory. Thus, obesity-related changes in left heart geometry and function begin to appear in infancy. Our data support the importance of preventing obesity from early infancy.

Introduction: C-type natriuretic peptide (CNP) is an endogenous paracrine mediator released by endothelial cells and cardiomyocytes during inflammation and cardiac stress. CNP is known to regulate various aspects of myocardial structure and function including myocyte contractility, coronary vascular reactivity and fibrosis. However, an intrinsic role for the peptide in offsetting the pathogenesis of heart failure with preserved ejection fraction (HFpEF) remains unsubstantiated. Aim: To investigate whether endogenous CNP preserves diastolic function in the setting of HFpEF by maintaining cardiac structure, reducing myocardial fibrosis, and dampening inflammation. Methods: Endothelial (ecCNP -/- ) and cardiomyocyte (cmCNP -/- ) -restricted CNP knockout and natriuretic peptide receptor-C (NPR-C -/- ) knockout mice were subjected to a high fat diet (HFD) plus N G -nitro-L-arginine methyl-ester (L-NAME; 100mg/kg/day; p.o.) ‘two-hit’ model of HFpEF. Echocardiography was performed at baseline and endpoint to assess cardiac structure and function. Blood pressure, heart weight and lung wet weight were determined, and cardiac sections processed to establish fibrotic burden and immune cell infiltration. Results: ecCNP -/- animals developed a more severe HFpEF phenotype in comparison to WT littermates, as illustrated by greater diastolic dysfunction (e.g. isovolumetric relaxation time, IVRT; myocardial performance index, MPI) and greater myocardial immune cell infiltration. In contrast, whilst cmCNP -/- animals did not exhibit any overt deficiency in diastolic function in experimental HFpEF, myocardial fibrosis was exacerbated in these mice. Interestingly, diastolic dysfunction (e.g. IVRT, MPI, E/e’) and fibrotic burden were also significantly greater in mice lacking the cognate receptor NPR-C suggesting it is this NPR subtype that underpins the combined beneficial actions of endothelial and cardiomyocyte -derived CNP. Conclusions: Endogenous CNP, of endothelial and cardiomyocyte origin, plays an important role in mitigating the development of diastolic dysfunction, inflammation and ventricular stiffening in HFpEF; this salutary action is underpinned by activation of NPR-C. Targeting CNP/NPR-C signalling may therefore be of therapeutic benefit in this disorder. Funding: British Heart Foundation Programme Grant (RG/F/23/110123) and Biotechnology and Biological Sciences Research Council CASE PhD studentship (BB/W509991/1).

Introduction: Gestational diabetes mellitus is increasingly recognized as a risk factor for adverse fetal cardiovascular remodeling. Hyperglycemia during pregnancy may lead to altered fetal myocardial development, particularly affecting septal thickness and myocardial function. However, standardized fetal cardiac markers and the magnitude of these changes remain under-investigated. Hypothesis: We hypothesized that fetuses of mothers with GDM exhibit statistically significant increases in interventricular septal thickness and impaired cardiac function compared to fetuses of normoglycemic mothers during the third trimester. Methods: A prospective cohort study was conducted involving 120 pregnant women diagnosed with GDM and 120 matched normoglycemic controls between 28–34 weeks of gestation. All participants underwent fetal echocardiography using standardized M-mode and Doppler measurements. Parameters assessed included IVST, left ventricular myocardial performance index, and E/A ratio. Maternal HbA1c levels were measured concurrently. Statistical analysis was performed using SPSS with independent t-tests and Pearson correlation coefficients; p-values &lt; 0.05 were considered statistically significant. Results: Fetuses in the GDM group exhibited significantly increased IVST (mean ± SD: 4.83 ± 0.45 mm) compared to controls (3.97 ± 0.51 mm), p &lt; 0.001. The myocardial performance index was also elevated in the GDM group (0.55 ± 0.06) versus controls (0.48 ± 0.05), p &lt; 0.001, indicating impaired global myocardial function. A moderate positive correlation was observed between maternal third-trimester HbA1c and fetal IVST (r = 0.58, p &lt; 0.01), and a negative correlation with E/A ratio (r = –0.41, p &lt; 0.05), suggesting diastolic dysfunction. Conclusion: Third-trimester fetuses of GDM mothers demonstrate statistically significant myocardial hypertrophy and impaired cardiac function. These findings support the use of fetal echocardiography in GDM pregnancies to enable earlier identification of cardiometabolic risk. Glycemic control, as indicated by maternal HbA1c, appears moderately correlated with the severity of fetal cardiac remodeling.

Right ventricular dysfunction (RVD) with severe tricuspid regurgitation is a major prognostic factor in cardiopulmonary disease, yet the effects of improving tricuspid regurgitation remains unknown. In this study, we evaluated the effects of a novel percutaneous tricuspid valve replacement device (or TVR, Evoque®) on RVD utilizing the right ventricular index of myocardial performance (RIMP, or Tei index). The RIMP encompasses both systolic and diastolic components of right ventricular function. We prospectively analyzed our first 10 patients with severe tricuspid regurgitation undergoing percutaneous TVR. RIMP was measured via echocardiography both before and after percutaneous TVR and compared to normal controls. Patients with RVD had significantly elevated RIMP values (mean 0.55 -/+ 0.08) compared to controls (mean 0.32 -/+ 0.05, p &lt; 0.001). Following percutaneous TVR using the Evoque device, there was a significant reduction in RIMP (mean 0.41 -/+ 0.06, P&lt;0.01), demonstrating an improved global RV function. These findings are correlated with improved invasive hemodynamics and measurements of quality of life. Conclusions: Improving severe tricuspid regurgitation with percutaneous TVR in patients with RVD results in an improvement in global right ventricular function as assessed by the RIMP. This study further highlights RIMP as a reliable marker of RV dysfunction and demonstrates it's responsiveness to interventions that alleviate volume overload from severe TR. Further studies assessing the effect of the improved hemodynamics from percutaneous TVR on patient outcome are ongoing.

Abstract Background Diabetes mellitus in pregnancy increases the risk of numerous complications in the neonate. Fetal epicardial fat tissue thickness (EFT) has emerged as a new marker of cardiometabolic risk in infants of diabetic mothers. Aim of the Work This study aims at assessment of epicardial fat thickness in newly born Infants of Diabetic Mothers and its relation to the umbilical cord glycated albumin level as an indicator of glycemic control in the newborn. Subjects and Methods This Cross sectional- case control study included 35 neonates born to diabetic mother, patients were recruited from Ain Shams University obstetric and gynecological hospital in conjunction with neonatology unit from februray 2024 till august 2024. They were compared to a group of healthy thirty newborns matched in age and sex. To all enrolled subjects, umblical cord sample was withdrawn after birth to measure glycated albumin level. Full perinatal history was taken and clinical examination was done to all subjects including cardiac examination and anthropometric measurses. Then ECHO was done to all newborns during first week of life including all cardiac dimensions, minor cardiac anomalies, epicardial fat thickness and myocardial performance index. Results The study examined 35 infants of diabetic mothers (IDM) and found no significant differences in demographic data or anthropometric measures compared to controls. Epicardial fat thickness (EFT) was significantly higher in IDM (18.22±1.78 mm) than controls, with a positive correlation between EFT and functional pulmonary hypertension (p = 0.000). Glycated albumin was also higher in IDM, correlating with hypertrophic cardiomyopathy (p = 0.043), there was a positive correlation between epicardial fat thickness and glycated albumin( p = 0.003). Conclusion epicardial fat thickness (EFT) was significantly higher in IDMs compared to controls, correlating with elevated glycated albumin (GA) denoting possible relationship to short term glycemic control.

ABSTRACTObjectiveAlthough spectral tissue Doppler imaging is recognized as the optimal method for assessing the fetal myocardial performance index (MPI), longitudinal reference ranges for fetal MPI measured using spectral tissue Doppler have not been established. Our objective was to use spectral tissue Doppler data to establish gestational‐age‐specific reference ranges from 12–33 weeks for left and right ventricular fetal MPI.MethodsThis was a prospective longitudinal study of women aged 18–35 years, with a body mass index below 30 kg/m2 and a singleton pregnancy conceived spontaneously. Fetal MPI measurements were obtained in the first, second and third trimesters and MPI was determined using spectral tissue Doppler imaging. A generalized additive model for location, scale and shape (GAMLSS) was used to explore the relationship between fetal MPI and gestational age. Model fit was assessed by checking the normality of estimated Z‐scores across the fitted range and independency from gestational age.ResultsMedian fetal MPI was determined for the right and left ventricles at 12–13 weeks, 20–21 weeks and 32–33 weeks' gestation in 90 fetuses. Using multilevel regression modeling, weekly reference ranges for each gestational age were created to provide a continuous characterization of normal fetal MPI assessed using spectral tissue Doppler throughout pregnancy. Percentile reference ranges (5th, 10th, 25th, 50th, 75th, 90th and 95th) for right and left ventricular fetal MPI were generated from these models, capturing normal variability across gestation.ConclusionWe have established gestational‐age‐specific reference ranges for left and right ventricular fetal MPI using spectral tissue Doppler imaging, thus providing clinicians with an important tool for the early detection of fetal cardiac dysfunction in high‐risk pregnancies. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

ObjectiveExercise-induced premature ventricular complexes (EI-PVCs) are key indicators of subclinical cardiac dysfunction and elevated cardiovascular risk. However, their clinical significance and prognostic value remain unclear, particularly in asymptomatic individuals without structural heart disease. This study uses advanced echocardiographic techniques to investigate the relationship between EI-PVCs and subclinical myocardial dysfunction.MethodsAn observational case-control study was conducted with 141 participants (82 controls and 59 cases). Two-dimensional speckle tracking echocardiography (2D-STE) was utilized to assess myocardial function, including global longitudinal strain (GLS).ResultsParticipants with exerciseinduced PVCs exhibited significantly greater left ventricular mass index (80.1 ± 15.7 vs. 74.3 ± 12.7 g/m²; p = 0.035), markedly reduced global longitudinal strain (–19.6 ± 2.0% vs. − 22.2 ± 1.4%; p < 0.001), and elevated myocardial performance index (0.42 ± 0.07 vs. 0.38 ± 0.06; p = 0.002) compared to controls, despite similar conventional systolic parameters.ConclusionThis study highlights EI-PVCs as early markers of subclinical myocardial dysfunction, warranting detailed echocardiographic evaluation in affected individuals. The findings. underscore the need for further research into the burden, morphology, and patterns of EI-PVCs to refine cardiovascular risk stratification and management strategies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12947-025-00353-3.