Strengths and limitations
All echocardiographic examinations were performed and analysed by experienced operators and the longitudinal design adds strength to our findings. However, the examinations were technically challenging in the obese group and two patients were removed from analysis due to inadequate quality. Women who attended a minimum of two out of three scans were included, four women had two rather than three scans (two from each group). Although the number of women with normal BMI was low, the findings in that group were consistent with the published literature.8