Background/Objectives: Fetal growth restriction (FGR), historically termed intrauterine growth restriction (IUGR), is a multifactorial condition in which the fetus fails to reach its genetically determined growth potential, most often due to placental insufficiency. Beyond its link with increased perinatal morbidity and mortality, FGR has been associated with long-term cardiovascular risk through early-life programming. The developing fetal heart is vulnerable to chronic hypoxia and nutrient deprivation, potentially inducing structural and functional alterations with lifelong consequences. This narrative review summarizes and critically appraises experimental and clinical evidence on the impact of FGR on myocardial development and cardiovascular health from fetal life to adulthood. Methods: We conducted a narrative review using a structured literature search of studies published in the last 15 years in PubMed and Scopus, focusing on experimental, imaging, and epidemiological research evaluating cardiac structure, function, and long-term cardiovascular outcomes in FGR. Evidence from fetal and neonatal echocardiography, including Doppler and speckle-tracking techniques, as well as molecular and histological studies, was examined. No statistical meta-analysis was performed. Results: FGR has been associated with reduced cardiomyocyte number, altered myocardial architecture, increased interstitial fibrosis, and persistent ventricular remodeling. Functional studies suggest early impairments in systolic and diastolic performance, with alterations in cardiac energy metabolism and epigenetic regulation. Advanced imaging may enable detection of subclinical cardiac dysfunction in utero and early postnatally. Epidemiological data suggest an increased risk of hypertension, ischemic heart disease, heart failure, and metabolic disorders in adulthood among individuals born growth-restricted. Conclusions: FGR represents an early cardiovascular risk condition. Improved understanding of fetal cardiac programming may help refine risk stratification, surveillance, and preventive strategies to reduce long-term cardiovascular morbidity in individuals born growth-restricted.

The endocrine system plays a pivotal role in all stages of cardiac development and in maintaining the structural and functional integrity of the heart. Notably, the heart itself functions as an endocrine organ, producing hormones that regulate blood pressure, fluid balance, and myocardial remodeling. This narrative review explores the endocrine mechanisms underlying cardiac development and function, with a focus on fetal and pediatric life. Special attention is given to the heart’s intrinsic endocrine activity and how hormonal signals interact with the cardiovascular system during early development. Hormonal signaling is essential for maintaining physiological homeostasis and supporting proper heart development during growth. Disruptions in these signals may serve as silent precursors to structural or functional heart disease, potentially manifesting later in life. Understanding these interactions is clinically relevant, as endocrine imbalances can contribute to the onset, progression, and prognosis of pediatric cardiac disorders. Early identification of hormonal dysregulation can help prevent or mitigate adverse cardiovascular outcomes. Furthermore, recognizing age-specific patterns in hormone–heart interactions may enable the development of targeted diagnostic and therapeutic strategies.