Cardiac strain in patients on Janus Kinase inhibitors for rheumatic diseases: a 1-year echocardiographic study

Abstract

Objectives: Janus kinase inhibitors (JAKi) are increasingly used to treat autoimmune rheumatic diseases (ARDs), despite concerns regarding their potential cardiovascular risks. Cardiac strain, a sensitive marker for subclinical myocardial dysfunction, can predict the risk of heart failure. This study aims to evaluate the effect of JAKi on cardiac strain and function in patients with ARDs in routine clinical practice.

Methods: This prospective Greek cohort study enrolled patients diagnosed with RA, PsA, or axSpA initiating treatment with a JAKi (baricitinib, tofacitinib, or upadacitinib). Comprehensive assessments were performed at baseline, 6 months, and 12 months including disease-specific scores and laboratory tests. Transthoracic speckle-tracking echocardiography was used to assess global longitudinal strain (GLS), left ventricular ejection fraction (EF), and right ventricular function (including RV GLS, TAPSE, and S'RV). Diastolic function was evaluated through the E/A and E/E' ratios.

Results: Thirty patients completed the study: 12 with axSpA, 10 with RA, and 8 with PsA. Disease activity significantly improved across all cohorts. No significant changes in GLS, EF, E/A, E/E', TAPSE, S'RV or heart rate were observed from baseline to 12 months. Additionally, the GLS of the left ventricle did not show a decline.

Conclusions: In this cohort, JAKi did not result in significant changes in cardiac strain or function over one year in patients with ARDs, suggesting that JAKi may not have a detrimental impact on cardiac function in the short term. However, longer-term studies with larger cohorts are necessary to evaluate potential delayed effects and confirm the cardiovascular safety of JAKi.