BACKGROUND: Hypertensive pregnancy disorders are associated with adverse cardiac remodeling, which can fail to reverse in the postpartum period in some women. The Physician-Optimized Postpartum Hypertension Treatment trial demonstrated that improved blood pressure control while the cardiovascular system recovers postpartum associates with persistently reduced blood pressure. We now report the effect on cardiac remodeling. METHODS: In this prospective, randomized, open-label, blinded end point trial, in a single UK hospital, 220 women were randomly assigned 1:1 to self-monitoring with research physician-optimized antihypertensive titration or usual postnatal care from a primary care physician and midwife. Participants were 18 years of age or older, with preeclampsia or gestational hypertension, requiring antihypertensives on hospital discharge postnatally. Prespecified secondary cardiac imaging outcomes were recorded by echocardiography around delivery, and again at blood pressure primary outcome assessment, around 9 months postpartum, when cardiovascular magnetic resonance was also performed. RESULTS: A total of 187 women (101 intervention; 86 usual care) underwent echocardiography at baseline and follow-up, at a mean 258±14.6 days postpartum, of which 174 (93 intervention; 81 usual care) also had cardiovascular magnetic resonance at follow-up. Relative wall thickness by echocardiography was 0.06 (95% CI, 0.07–0.05; P <0.001) lower in the intervention group between baseline and follow-up, and cardiovascular magnetic resonance at follow-up demonstrated a lower left ventricular mass (–6.37 g/m ² ; 95% CI, –7.99 to –4.74; P <0.001), end-diastolic volume (–3.87 mL/m ² ; 95% CI, –6.77 to –0.98; P =0.009), and end-systolic volume (–3.25 mL/m ² ; 95% CI, 4.87 to –1.63; P <0.001) and higher left and right ventricular ejection fraction by 2.6% (95% CI, 1.3–3.9; P <0.001) and 2.8% (95% CI, 1.4–4.1; P <0.001), respectively. Echocardiography-assessed left ventricular diastolic function demonstrated a mean difference in average E/E’ of 0.52 (95% CI, –0.97 to –0.07; P =0.024) and a reduction in left atrial volumes of –4.33 mL/m ² (95% CI, –5.52 to –3.21; P <0.001) between baseline and follow-up when adjusted for baseline differences in measures. CONCLUSIONS: Short-term postnatal optimization of blood pressure control after hypertensive pregnancy, through self-monitoring and physician-guided antihypertensive titration, associates with long-term changes in cardiovascular structure and function, in a pattern associated with more favorable cardiovascular outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04273854.

Gestational diabetes mellitus (GDM) affects approximately 14% of pregnancies globally, with rising incidence depending on the diagnostic criteria used. In the UK, screening relies on risk factors at booking, followed by a diagnosis via an oral glucose tolerance test in the second trimester. This approach may lack sensitivity and has poor tolerability. Emerging evidence suggests that GDM pathophysiology begins in the first trimester, with biomarkers showing potential for early prediction. Identifying these could enable earlier risk stratification, improved diagnostic pathways, and better maternal–fetal outcomes. This scoping review maps the existing literature on first‐trimester biomarkers of GDM to evaluate their clinical utility and integration into predictive models. A literature search was conducted using Medline, Embase, and PubMed to identify studies on first‐trimester biomarkers of GDM. Inclusion criteria included (1) studies investigating biomarkers at <15 weeks' gestation; (2) studies that diagnosed GDM using an OGTT with recognized diagnostic guidelines or clearly stated glucose thresholds. A total of 133 studies were included, reporting a wide range of biomarkers (145 in total). PAPP‐A was generally lower in GDM, with mixed findings for β‐hCG and PlGF. Metabolic markers, including lipid profiles, fasting glucose, and HbA1c, were often elevated. Inflammatory markers, such as WCC, neutrophils, and CRP, were higher in those later diagnosed with GDM. First‐trimester biomarkers highlight GDM's complex pathophysiology. PAPP‐A shows predictive potential, while metabolic and inflammatory biomarkers suggest early systemic dysfunction. Emerging tools like 3D ultrasonography indicate placental structural changes. Larger studies are needed to validate these biomarkers and integrate them into predictive models to improve maternal–fetal outcomes.

BACKGROUND: Hypertensive pregnancy disorders are associated with long-term adverse cardiac and vascular remodeling postindex pregnancy. The POP-HT trial (Physician Optimised Postpartum Hypertension Treatment) demonstrated that improved puerperal blood pressure control leads to reduced blood pressure and beneficial cardiac remodeling during the first year postpartum. This study describes the impact on postpartum vascular remodeling. METHODS: A prospective, randomized, open-label, blinded end point trial in a single UK hospital where 220 women were assigned 1:1 to intervention (self-management via physician-guided antihypertensive titration) or control (usual postnatal care via primary care doctor±midwife). Eligible participants were ≥18 years, with preeclampsia or gestational hypertension and requiring antihypertensives on discharge. Prespecified secondary vascular outcomes included aortic blood pressure and pulse wave velocity measured by Vicorder at baseline and 9 months postpartum, and additional cardiovascular magnetic resonance measures of aortic distensibility were performed. RESULTS: There were no baseline differences in aortic blood pressure or pulse wave velocity but by 9 months postpartum, aortic diastolic blood pressure was −5.2 mm Hg lower ([95% CI, −8.0 to −2.2]; P <0.001), and pulse wave velocity was −0.71 m/s lower ([95% CI, −1.42 to −0.006]; P =0.048) in the intervention arm compared with the control arm, which corresponded with greater aortic distensibility by 0.78×10 ^{− 3} mm Hg ^{− 1} ([95% CI, −0.01 to 1.55]; P =0.046). CONCLUSIONS: Postpartum blood pressure self-monitoring combined with physician-guided medication titration is associated with reduced central arterial stiffness during the first year after a hypertensive pregnancy, in addition to the previously demonstrated effects on blood pressure and cardiac remodeling. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04273854.

Echocardiography is a first-line, non-invasive imaging modality widely used to assess cardiac structure and function; however, its interpretation remains highly operator dependent and subject to variability. The integration of artificial intelligence (AI) into echocardiographic practice holds the potential to transform workflows, enhance efficiency, and improve the consistency of assessments across diverse clinical settings. Interest in the application of AI to echocardiography has grown significantly since the early 2000s with AI models that assist with image acquisition, disease detection, measurement automation, and prognostic stratification for various cardiac conditions. Despite this momentum, the safe and effective deployment of AI models relies on rigorous development and validation practices, yet these are infrequently described in the literature. This narrative review aims to provide a comprehensive overview of the essential steps in the development and validation of AI models for echocardiography. Additionally, it explores current challenges and outlines future directions for the integration of AI within echocardiography.

Background: Cardiac damage (CD) is prevalent across the spectrum of aortic stenosis (AS) and is a strong predictor of adverse outcomes. The natural history of CD in early AS and drivers of its progression, are poorly defined. We aimed to identify predictors and the prognostic significance of CD progression in patients with non-severe AS. Methods: This was a single centre cohort study with longitudinal follow-up. Patients with mild or moderate AS at baseline and over serial echocardiographic follow-up were evaluated for the presence and progression of CD over time. Results: 1751 patients were included. At baseline, CD was present in 1320 (75%), categorized as stage 1 in 231 (13%), stage 2 in 672 (38%), stage 3 in 109 (6%) and stage 4 in 308 (18%). Over a median follow-up of 2.1 [Q1–Q3 1.1-3.6] years, the prevalence of advanced-stage (stages 3 and 4) CD increased from 24% to 30%. Factors associated with progression to advanced-stage CD included comorbidity burden (adjusted OR [aOR] 1.23 per additional comorbidity; 95% CI: 1.10–1.38; p < 0.001) and the presence of atrial fibrillation (aOR 3.23; 95% CI: 1.15–9.07, p = 0.024) or left atrial dilation (aOR 1.55; 95% CI: 1.11–2.16, p = 0.010)], but not AS severity. Progression of CD was independently associated with all-cause mortality (adjusted HR [aHR] 1.35; 95% CI: 1.07–170; p = 0.012). Conclusions: In non-severe AS, CD is common and frequently progresses over time. CD progression appears to be driven by comorbidities and pre-existing myocardial remodelling and is an independent predictor of all-cause mortality.