Search Results (182)

Background/Objectives: The FIB-4 index is a laboratory test for predicting liver fibrosis. The aim of this study was to investigate the association between FIB-4 index and hematoma expansion in patients with intracerebral hemorrhage (ICH). Methods: A retrospective review was made of the records of 98 consecutive patients with ICH, separated into two groups according to the FIB-4 index: Group 1 (FIB-4 ≤ 2.67) and Group 2 (FIB-4 > 2.67). The demographic data, admission National Institutes of Health Stroke Scale (NIHSS) scores, hematoma volume on admission and follow-up cranial computed tomography (CT) within 72 h of admission, hematoma extension, mortality, and modified Rankin Scale (mRS) scores at discharge and the first follow-up visit were recorded. Results: Group 1 (FIB-4 ≤ 2.67) included 75 patients (28 (37.3%) females, 47 (62.7%) males) and Group 2 (FIB-4 > 2.67) included 23 patients (6 (26.1%) females, 17 (73.9%) males). The results of multivariable regression analysis to evaluate predictors of hematoma expansion showed an independent association of age and FIB-4 index > 2.67 with hematoma expansion. Increasing age was associated with a lower likelihood of hematoma expansion (OR 0.941, 95% CI 0.901–0.983, p = 0.012). A FIB-4 index > 2.67 indicated a markedly increased predisposition to hematoma expansion compared to a FIB-4 index ≤ 2.67 (OR 4.12, 95% CI 1.215–13.980, p = 0.032). Conclusions: The results of this study showed that an elevated FIB-4 index was associated with hematoma expansion. Large-scale prospective studies are needed to confirm this relationship and provide valuable insights for clinical practice. Full article

Objectives: In patients presenting to the emergency department with acute ischemic stroke (AIS), there is a growing need for practical and rapid biomarkers that can effectively predict prognosis and infarct volume, complementing neurological examination and imaging methods. Methods: This study retrospectively evaluates patients diagnosed with AIS at the emergency department of Bilecik Training and Research Hospital between 1 March 2022, and 30 September 2023. Patients who were transferred for reperfusion therapy were excluded, as thrombolysis and mechanical thrombectomy were not available at our institution during the study period. The systemic immune–inflammation index (SII) and the systemic inflammation response index (SIRI) scores were calculated based on patients’ laboratory values. Additionally, infarct volumes were independently assessed by two experienced radiologists and calculated by multiplying the hyperintense areas on diffusion-weighted magnetic resonance imaging by slice thickness. Results: Of the 349 patients diagnosed with AIS during this study period, 257 who met the inclusion criteria were analyzed. The median age was 76 years (IQR: 66–83), and 130 (51%) patients were female. Lacunar infarction was present in 109 patients (42.4%), while 148 (57.6%) had non-lacunar infarction. The all-cause mortality rates at 1 month, 1 year, and 2 years were 7.8%, 21.4%, and 29.6%, respectively. SII and SIRI scores were significantly higher in deceased patients compared to survivors across all time points for mortality. Conclusions: The findings of this study suggest that SII and SIRI values, derived from complete blood count parameters, may contribute to the early identification and management of high-risk AIS patients. Full article

Introduction: Gestational physiology is characterized by an expansion of plasma volume and an elevation in cardiac output. Given the scarcity of existing data on pregnancy-related left atrial (LA) volumetric and functional features, this study aims to define LA volumes, volume-based functional properties and strains in healthy subjects during mid-term pregnancy. Methods: The present study comprised 19 healthy women in mid-term pregnancy (mean age: 30.5 ± 2.7 years, weight: 81.7 ± 14.0 kg, height: 166.9 ± 5.7 cm) without any symptoms, known diseases or other conditions, which could affect the results. Their results were compared to those of 43 healthy non-pregnant women (mean age: 28.6 ± 4.9 years, weight: 59.9 ± 8.5 kg, height: 167.8 ± 7.6 cm). All participants underwent comprehensive two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE). Results: Thicker interventricular septum, increased left ventricular ejection fraction and impaired early and late transmitral flow velocities could be detected in healthy pregnant subjects as compared to those of non-pregnant individuals. End-systolic maximum LA volume was increased with elevated stroke volume and emptying fraction. While early diastolic LA volume was preserved with elevated stroke volume and emptying fraction, late diastolic LA volume, stroke volume and emptying fraction remained unchanged. However, indexed LA volumes did not differ between the groups. Among end-systolic peak global LA strains, only LA longitudinal strain (LS) was increased, while all others remained unchanged. Among regional strains, basal, midatrial and superior LA circumferential strain (CS) and LA-LS were increased except for basal LA-CS, which was impaired. Among late diastolic LA strains at atrial contraction, none of them showed any significant changes in healthy pregnant subjects compared with those of non-pregnant women. Conclusions: With a detailed 3DSTE study, elevated end-systolic LA volume and preserved diastolic LA volumes, together with enhanced end-systolic LA reservoir and early diastolic LA conduit functional properties, could be detected with features of preserved late diastolic booster pump function in healthy women during mid-term pregnancy (second trimester). When comparing indexed LA volumes, no significant difference could be confirmed between the pregnant and non-pregnant groups. This suggests that the increased end-systolic LA volume may be an adaptation to increased body weight. Full article

Introduction: Health problems related to cardiovascular morbidity and mortality are overrepresented in patients with schizophrenia (SCH) and their rates have not declined in parallel with those of the general population. Cardiovascular diseases in patients with SCH are less likely to be diagnosed and treated, and data regarding structural and functional cardiac abnormalities—particularly those involving the left atrium (LA)—remain limited in this population. The present study is the first to provide a detailed three-dimensional speckle-tracking echocardiography (3DSTE)-derived volumetric and functional evaluation of LA properties in patients with chronic SCH compared with age-, gender- and body mass index (BMI)-matched healthy controls (HCs). Methods: A total of 36 patients with SCH were initially enrolled, from which 19 subjects (53%) were excluded due to inferior image quality. Ultimately, 17 SCH patients (mean age: 45.2 ± 7.7 years; 9 males, 53%) were compared with 40 age- and gender-matched HCs (mean age: 42.5 ± 5.7 years; 23 males, 58%). All participants underwent comprehensive two-dimensional Doppler echocardiography and 3DSTE. Results: LA volumes respecting the cardiac cycle were lower in SCH patients compared with controls. Among LA volume-derived functional properties, total and active LA stroke volumes were reduced in patients with chronic SCH, whereas passive LA emptying fraction was increased. All global and mean segmental peak LA strain parameters tended to be increased in SCH patients, with global and mean segmental LA area strain (AS) and mean segmental LA radial strain (RS) reaching statistical significance. Regarding regional peak LA strains, basal LA circumferential strain (CS) and LA-AS, as well as superior LA longitudinal strain (LS), LA-CS, and LA-AS, differed significantly between the groups. All global and mean segmental LA strain parameters measured at atrial contraction tended to be increased in chronic SCH patients, with global and mean segmental LA-AS and mean segmental LA-RS and LA-LS reaching statistical significance. Regional LA strains during atrial contraction demonstrated increased superior LA-RS, LA-CS, LA-LS and LA-AS, along with elevated mid-atrial LA-RS, LA-AS and LA-3D strain. All these abnormalities suggest reduced LA volumes in all phases of LA function, accompanied by overcompensating functional alterations. Conclusions: Chronic schizophrenia is associated with marked volumetric and functional abnormalities of the left atrium. These findings highlight the need for comprehensive cardiac functional evaluation extending beyond left ventricular-centered analysis in patients with this severe mental illness. Full article

Aortic valve stenosis (AS) is assessed by echocardiography in clinical practice. Conventionally, the aortic valve area, peak transaortic valve velocity/gradient and the mean transvalvular gradient determine if the AS is categorized as mild, moderate or severe. Recently, the entity of paradoxical low-flow, low-gradient AS despite normal left ventricular ejection fraction (LVEF) was described and flow (as determined by stroke volume indexed to body surface area) was used to further categorize AS. The new European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) guidelines in 2025 recommended a new phenotype-based classification, which improved the prognostication of AS. There are now five phenotypes: (1) concordant high-gradient AS; (2) low-flow, low-gradient AS with reduced LVEF; (3) low-flow, low-gradient AS with preserved LVEF; (4) normal-flow, low-gradient AS with preserved LVEF; and (5) discordant high-gradient AS. These appear to have different underlying pathophysiology, and hence prognostication and therapy. In addition, categories of AS in the setting of reduced LVEF are further divided based on their responses to dobutamine or exercise stress, which may result in different therapeutic strategies. In the transaortic valvular replacement (TAVR) versus the surgical aortic valve replacement (SAVR) era, the classification of these AS groups may have differing implications on the appropriate interventions. Furthermore, there are investigations on the effect of AS on the left ventricle and other chambers and stages of AS based on the extent of cardiac damage, which may have important prognostic value post-AVR. On the other spectrum, there are new developments in imaging analysis, such as using artificial intelligence. This state-of-the-art paper will comprehensively review the important updates in AS and its clinical implications. Full article

Background/Objectives: Cognitive impairment is highly prevalent in atrial fibrillation (AF) and frequently occurs in the absence of overt stroke, implicating non-embolic mechanisms. We hypothesized that atrial remodeling and impaired cerebral hemodynamics are associated with mild cognitive impairment (MCI) in permanent AF. Methods: In this cross-sectional study, 252 stroke-free patients with permanent AF receiving direct oral anticoagulants (DOACs) underwent transthoracic echocardiography and transcranial Doppler (TCD) assessment of middle cerebral artery flow. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were analyzed. Multivariable logistic regression identified factors independently associated with MCI, and receiver operating characteristic (ROC) curves evaluated discriminative performance. Results: MCI was present in 40% of patients (101/252). AF-MCI patients were older and showed greater left atrial remodeling, reflected by increased left atrial diameter and left atrial volume index (LAVI) (both p ≤ 0.001), without differences in left ventricular systolic function. TCD demonstrated reduced EDV and increased RI in the MCI group (all p ≤ 0.01), whereas PSV showed minimal differences. In multivariable analysis, age, LAVI, and average RI were independently associated with MCI. Age showed excellent discrimination (AUC 0.858), whereas maximum RI demonstrated moderate discrimination (AUC 0.645; p < 0.001 for comparison). Conclusions: In stroke-censored permanent atrial fibrillation, cognitive impairment was associated with atrial remodeling and impaired diastolic cerebral perfusion, consistent with a potential contribution of chronic hypoperfusion and increased microvascular resistance. Combined echocardiographic and cerebral hemodynamic assessment may help characterize hemodynamic patterns associated with cognitive impairment in AF. Full article

Background: Frail patients undergoing hip and knee revision surgery represent a major anesthetic challenge because of advanced age and multiple comorbidities. Continuous spinal anesthesia (CSA) with titrated low-dose levobupivacaine may offer a potentially useful alternative to general anesthesia or single-shot spinal anesthesia in this high-risk population. Methods: A retrospective review was conducted of ASA II-III patients who underwent complex hip and knee revision surgeries between February and October 2024 under CSA. The technique was performed using a 25-gauge spinal catheter with incremental boluses of 0.25% levobupivacaine (2.5 mg). Hemodynamic parameters, including mean arterial pressure (MAP), stroke volume index (SVI), and cardiac index (CI), were continuously monitored using the EV1000 hemodynamic monitoring system. Postoperative complications were recorded. Results: 37 high-risk patients were included in the study. Catheter placement was successful in all patients, with no conversions to general anesthesia. MAP decreased by a mean of 14.6% after boluses (p < 0.05); 9 patients (24.3%) experienced reductions ≥ 20%, but all remained >65 mmHg and responded to fluid therapy. CI and SVI decreased by 10.1% and 10.5%, respectively (p < 0.05), without clinical instability. No major complications (neurological injury, infection, post-dural puncture headache) were observed. Conclusions: In this retrospective single-center experience, CSA with titrated low-dose levobupivacaine was feasible and associated with stable hemodynamic profiles and a low rate of complications in frail patients undergoing complex lower-limb revision surgery. However, given the absence of a control group and the limited sample size, these findings should be interpreted cautiously. Further prospective comparative studies are needed to better define the role of CSA in high-risk orthopedic patients. Full article

Background and Objectives: Acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) remains a major cause of disability and mortality. Mechanical thrombectomy (MT) improves outcomes, but recovery varies. This study assessed the prognostic value of hypoperfusion intensity ratio (HIR), collateral circulation, and other clinical/imaging factors. Materials and Methods: This retrospective cohort study included 96 LVO patients treated with MT with or without intravenous thrombolysis (IVT) between 2020 and 2024 at a tertiary hospital. Inclusion required multimodal CT (CT, CTA, CTP) and clinical data (NIHSS, mRS). HIR, core volume, CBV index, mismatch ratio, and collateral status were evaluated using artificial intelligence (AI)-based software. Univariate/multivariate logistic regression identified predictors of poor outcome (mRS > 3 at 90 days). Results: Lower HIR (<0.5) and good collaterals were associated with favourable outcomes (p < 0.001). Multivariate analysis identified HIR, initial NIHSS, and procedure duration as independent predictors of poor outcome. CTP-derived core volume, cerebral blood volume index, and mismatch ratio were also significant predictors. ROC analysis showed the highest AUC for core volume (0.810). Diabetes mellitus was associated with a worse prognosis compared to other clinical factors. Conclusions: HIR and collateral status are independent predictors of functional recovery after MT. CTP-derived core volume and CBV index have strong prognostic value. AI-based perfusion analysis supports patient selection and risk stratification. Full article

Background: Recent evidence suggests the potential role of fetal cardiac function parameters in the assessment of different obstetrical conditions. Despite this evidence, the application of cardiac function parameters to routine fetal cardiac evaluation is limited. Among other reasons, the lack of accessibility to a simple, practical instrument offering tips on how to carry out a fetal cardiac functional assessment could explain this restricted application. Methods: A narrative review of the available literature on how to practically carry out a fetal cardiac function assessment was reviewed and summarized to offer an instrument to assess fetal cardiac function alongside the classical morphological evaluation. Results: The contents of this guide are focused exclusively on the practical details to carry out a fetal cardiac function assessment and voluntarily exclude the definition of and indications for the parameters assessed. The guide includes the assessment of fetal cardiac morphometry, valvular evaluation and cardiac contractility. Conclusions: The aim of this guide is to make fetal cardiac functional parameters more accessible to maternal and fetal medicine health professionals with a good background knowledge of fetal cardiology. Full article

Objectives: This study aims to evaluate whether changes in perfusion index (PI) after the first deflation of the blood pressure cuff during remote ischemic conditioning (RIC) are associated with passive leg raising (PLR)-induced changes in stroke volume. In addition, we compared PI changes after cuff deflation during RIC between critically ill patients and healthy controls. Methods: This prospective, single-center study was conducted in a mixed ICU at a tertiary teaching hospital. Patients aged >18 years admitted to the ICU, monitored using calibrated pulse contour analysis, and scheduled for a PLR test as decided by the attending physicians were included. The PI was measured after blood pressure cuff deflations during RIC (3 cycles of brachial cuff inflation to 200 mmHg for 5 min, followed by instantaneous deflation to 0 mmHg for another 5 min) in the supine position after PLR. Preload responsiveness was defined as a ≥10% increase in the stroke volume index (SVI) during PLR. Data were compared with a healthy control group. Results: Thirty-three patients were included (median age 62; 45% in shock; 55% mechanically ventilated). When comparing critically ill patients with healthy volunteers, the maximum PI change (dPImax) and the time to reach it were higher in critically ill patients after the first and second cuff deflations (p < 0.05). However, after the third deflation, the difference was no longer significant. Following the first deflation, dPImax was significantly correlated with SVI changes during PLR (r = 0.63, p < 0.001). After the cuff was first deflated, we detected a PI cutoff with a positive SVI response (≥10%) during PLR, with a sensitivity of 64% and a specificity of 94% (area under the receiver operating characteristic curve 0.752; 95% CI, 0.564–0.940; p = 0.008). Conclusions: The maximum change in perfusion index following brachial blood pressure cuff deflation after five minutes of inflation may serve as a promising noninvasive bedside indicator of preload responsiveness in critically ill patients. Additionally, the observed normalization of PI kinetics during RIC suggests possible acute modulation of vascular reactivity, though further research is needed to confirm an association between PI changes and endothelial function. Full article

Background: Type 2 diabetes (T2D) increases cardiovascular disease (CVD) risk and predisposes individuals to heart failure with preserved ejection fraction. Metabolic dysfunction-associated steatotic liver disease (MASLD), prevalent in T2D, may worsen cardiac remodelling and haemodynamics. This secondary analysis of the DIASTOLIC trial examined the relationship of liver fat to cardiac remodelling in T2D at baseline and after a 12-week intervention or standard care. Methods: Adults with obesity and T2D and matched controls underwent hepatic MRI, cardiac MRI, echocardiography, and adipokine profiling as part of the DIASTOLIC study (NCT02590822). Participants with T2D were randomised to supervised exercise, a low-calorie meal-replacement plan (MRP), or routine care for 12 weeks. A baseline case–control and then pre- and post-analyses in those with T2D were performed. Associations between changes in liver fat and cardiovascular measures were assessed using correlation and adjusted generalised linear models. Results: At baseline, 81 T2D and 35 healthy controls were compared, and 76 subjects with T2D completed the trial. Participants with T2D had ~4× higher hepatic fat and adverse haemodynamics. The MRP arm achieved the greatest reductions in BMI, blood pressure, dysglycaemia, insulin resistance, and hepatic fat (−8.9%), with favourable adipokine changes. Overall, hepatic fat loss was associated with reductions in cardiac index and stroke volume and with additional reductions in end-diastolic volume in the MRP arm, independent of BMI. Conclusions: In T2D, hepatic fat is strongly linked to pathological haemodynamic profiles. Intensive caloric restriction achieves substantial hepatic fat loss and normalisation of hyperdynamic cardiovascular physiology independent of weight loss, identifying hepatic steatosis as a potential therapeutic target for early cardiovascular risk reduction. Full article

Background and Objectives: Pulmonary vein isolation (PVI) is an established rhythm control strategy for atrial fibrillation (AF). In many healthcare systems, increasing demand and limited procedural capacity have resulted in prolonged waiting times. The primary aim of this study was to evaluate the association between waiting time for PVI and AF progression. Secondary aims were to assess the relationship between waiting time and AF-related complications, healthcare utilization, and clinical factors associated with higher risk of progression. Materials and Methods: We performed a single-center observational cohort study of patients on the waiting list for PVI at Pauls Stradiņš Clinical University Hospital between 2016 and 2023. Results: A total of 341 patients completed structured ambulatory follow-up to assess the complication and progression rates of AF. The mean age was 64.8 ± 10.5 years, 50.9% were male, and the median waiting time was 37.2 months (IQR 15.0–61.3). AF progression occurred in 25.7% (n = 88) of patients, with longer waiting time independently associated with progression (OR, 1.017 per month; 95% CI, 1.006–1.028; p < 0.05). Electrical cardioversion during the waiting period was associated with a lower likelihood of progression (OR, 0.32; p = 0.029), and Class IC antiarrhythmic therapy was associated with reduced risk of AF progression (HR 0.78; p = 0.013). During follow-up, 45.2% of patients were hospitalized for AF paroxysms, 29.6% underwent electrical cardioversion, and 13.5% experienced complications including stroke and heart failure decompensation. Left atrial volume index and left ventricular ejection fraction were inversely correlated (ρ = −0.355, p < 0.05), but neither was associated with waiting time. Conclusions: Longer waiting times for PVI are associated with AF progression and substantial interim healthcare utilization due to complications. Strategies to prioritize higher-risk patients may help prevent disease progression and reduce complication burden. Full article

Exercise training has demonstrated potential benefits in addressing the adverse effects of cardiovascular diseases, particularly myocardial infarction (MI). This study analyzed the cardioprotective effects of moderate exercise before and after MI in rats subjected to isoproterenol (ISO)-induced heart damage. Wistar rats were assigned to five groups: controls (CTRL), isoproterenol-treated (ISO), swimming before ISO (PRE + ISO), swimming after ISO (ISO + POST), and swimming both before and after ISO (PRE + ISO + POST). Cardiac function was assessed through echocardiography, while oxidative stress markers, Heme Oxygenase-1 (HO-1) and Myeloperoxidase (MPO), were quantified using biochemical assays and enzyme-linked immunosorbent assay (ELISA). Statistical analyses were conducted by one-way analysis of variance (ANOVA), accompanied by Tukey’s post hoc test. Exercise performed post-MI and both pre- and post-MI significantly reduced ISO-induced infarct size and improved left ventricular function (stroke volume (SV), ejection fraction (EF), and Tei index). HO-1 protein concentration and HO enzyme activity were restored, while swim training reduced the activity of MPO compared to the ISO group. Moderate exercise training, when appropriately timed, provides cardioprotection against ISO-induced myocardial damage by reducing oxidative stress and cardiac dysfunction. Full article

Background/Objectives: Under general anesthesia, maintaining patients’ blood pressure (BP) is important to prevent organ ischemia. When bleeding occurs, it is sometimes difficult to increase BP with boluses of fluids or transfusions, and vasoconstrictors must be administered. This study investigated circulatory dynamic changes in patients who bled during surgery and were administered phenylephrine, particularly left ventricular end-diastolic volume (EDV), effective arterial elastance (Ea), and left ventricular end-systolic elastance (Ees), calculating each value from the left ventricular–arterial coupling (Ees/Ea). Methods: We calculated Ees/Ea using electrocardiograms, arterial pressure waveforms, and phonocardiograms using an esophageal stethoscope. We investigated the changes in patients’ EDV, Ea, and Ees during two periods: phenylephrine administration and after BP elevation. Results: The seven participants comprised three men and four women. Between the two periods, linear mixed-model analysis revealed that mean arterial pressure (MAP), Ea, and Ees significantly increased over time (MAP; β = 8.7, p < 0.01, Ea; β = 0.22, p < 0.05, Ees; β = 0.73, p < 0.05), while no significant changes were observed in other parameters such as heart rate and EDV. Conventional parameters demonstrated that stroke volume variation significantly decreased (β = −2.0, p = 0.01), systemic vascular resistance index significantly increased (β = 200, p < 0.01), while no significant change was observed in cardiac index (β = −0.03, p = 0.7). In patients administered phenylephrine due to BP decrease from bleeding, significant changes in afterload and cardiac contractility occurred without changes in preload. Conclusions: Our noninvasive method for calculating EDV, Ea, and Ees can be valuable for monitoring hemodynamics under anesthesia. Full article

Background/Objectives: Ethnicity is associated with differences in cardiac structure and function in non-pregnant populations, but pregnancy-specific data—particularly for myocardial deformation—remain limited. We investigated whether ethnicity influences cardiac geometry, biventricular and biatrial mechanics, hemodynamics, and carotid vascular indices in healthy women during the third trimester of pregnancy. Methods: In this prospective, monocentric study, 80 healthy women with singleton third-trimester pregnancies were enrolled, including 40 Asian and 40 Caucasian women matched for age and body mass index. All participants underwent standardized clinical and laboratory evaluation, comprehensive transthoracic echocardiography with Doppler, speckle-tracking analysis of both ventricles and atria, and bilateral carotid ultrasonography. Logistic regression analyses were performed in Asian women to identify correlates of supranormal left ventricular ejection fraction (LVEF ≥ 70%) and enhanced left ventricular global longitudinal strain (LV-GLS > 20%). Results: Age and gestational age were similar between groups, whereas body surface area was lower in Asian women (1.65 ± 0.12 vs. 1.77 ± 0.15 m², p < 0.001). Asian women exhibited smaller left ventricular dimensions and volumes but higher LVEF (median 71.6% vs. 66.4%, p < 0.001). Heart rate and blood pressure were comparable, whereas stroke volume [45.5 ± 9.6 vs. 68.0 (48.9–110) mL, p < 0.001] and cardiac output (3.9 ± 0.9 vs. 4.9 ± 0.8 L/min, p < 0.001) were lower in Asian women, who also demonstrated higher total peripheral resistance and lower ventricular–arterial coupling (0.31 ± 0.09 vs. 0.37 ± 0.07, p = 0.001). Speckle-tracking echocardiography revealed higher LV-GLS (21.9 ± 1.9% vs. 20.5 ± 2.0%, p = 0.002), higher LV global circumferential strain, enhanced right ventricular longitudinal strain, and higher reservoir strain of both atria in Asian women. Carotid ultrasonography showed smaller common carotid diameter and cross-sectional area in Asian women (10.7 ± 2.5 vs. 13.7 ± 2.3 mm², p < 0.001). In regression analyses, supranormal LVEF was independently associated with smaller LV end-diastolic diameter (OR 0.39, 95% CI 0.16–0.97), while enhanced LV-GLS was independently associated with lower neutrophil-to-lymphocyte ratio (OR 0.04, 95% CI 0.00–0.87). Conclusions: Ethnicity is associated with multidimensional differences in cardiac geometry, myocardial mechanics, vascular load, and carotid structure in healthy third-trimester pregnancy. Ethnicity-aware interpretation and tailored reference ranges may improve the accuracy of echocardiographic assessment during late gestation. Full article