OBJECTIVE The objective of the study was to evaluate echocardiographic markers of cardiac dysfunction in small-for-gestational age (SGA) fetuses with normal umbilical artery Doppler. METHODS Cardiac function was evaluated in 58 SGA (mean gestational age, 38 weeks) and 58 gestational-age matched normally grown fetuses by conventional echocardiography (peak early [E] and late [A] ratios and myocardial performance index [MPI]), and tissue Doppler imaging (TDI) (annular peak velocities and MPI'). RESULTS With conventional echocardiography, SGA fetuses had a nonsignificant trend to increased E/A ratios and left MPI compared with controls. TDI demonstrated that SGA fetuses had significantly lower right E' and A' peak velocities and higher MPI' values. CONCLUSIONS These findings further support that a proportion of SGA fetuses have true late-onset intrauterine growth restriction, which is associated with subclinical cardiac dysfunction, as previously described for early-onset intrauterine growth restriction.