People with primary Sjögren syndrome who feel perfectly well may still carry early signs of heart trouble that only a sensitive imaging technique can detect, according to a new cardiac magnetic resonance study published in BMC Rheumatology. The research, led by Qiming Liu and colleagues, found measurable differences in heart muscle function and tissue characteristics between patients and healthy controls, and these differences appeared most pronounced in patients with more active disease.
Cardiac involvement in these patients is often subclinical and underdiagnosed, meaning the heart can be affected without producing noticeable symptoms. The study set out to characterize these silent alterations using cardiac magnetic resonance imaging, or CMR, and to explore whether they relate to how active the disease is.
The retrospective study included 71 patients with primary Sjögren syndrome and 51 matched controls. Patients were grouped by disease activity using the ESSDAI score into low, moderate, and high activity categories. All participants underwent imaging on a 3.0 Tesla scanner. The assessments covered left ventricular function parameters, including ejection fraction and three measures of strain—global longitudinal, circumferential, and radial strain—as well as myocardial tissue characteristics measured through native T1 and T2 mapping.
The results showed a consistent pattern of subtle cardiac impairment in the patient group. Compared with controls, patients had a significantly lower left ventricular ejection fraction, at 61 percent versus 64 percent, a difference the authors reported as statistically significant. Patients also showed reduced global longitudinal strain, with values of minus 16 percent compared with minus 18 percent in controls. These figures indicate that the heart muscle was contracting slightly less effectively in patients, even though none of the changes would typically produce symptoms.
Tissue mapping added a second layer of findings. Patients had elevated global T2 values, 42.4 milliseconds versus 40.5 milliseconds in controls, and higher native T1 values, 1215.0 versus 1193.0 milliseconds. The authors concluded that asymptomatic patients exhibited subclinical myocardial dysfunction and edema detectable by CMR.
Importantly, the severity of these imaging abnormalities tracked with disease activity. The changes were most pronounced in the high-activity group, and statistical analysis of correlations supported this link. ESSDAI scores showed a moderate negative correlation with global radial strain, with a correlation coefficient of minus 0.302, and a weak positive correlation with global circumferential strain, at 0.288. In other words, patients with more systemic disease activity tended to show more deviation in the way their heart muscle deformed during contraction.
The study also identified clinical markers associated with the cardiac findings. Univariable and multivariable analyses identified rheumatoid factor levels above 20 IU/mL as an independent factor associated with decreased ejection fraction, with a beta coefficient of minus 3.79. Separately, the presence of Raynaud phenomenon was independently associated with increased T2 values, with a beta coefficient of 2.04. These associations suggest that specific, easily measured clinical features may help flag which patients carry the imaging abnormalities.
Based on these results, the authors suggested that CMR may be warranted for early cardiac evaluation in patients with primary Sjögren syndrome, particularly those with elevated rheumatoid factor or Raynaud phenomenon. The findings were reported in a version of the article shared early to provide faster access to peer-reviewed, accepted research, subject to further edits before the final version of record.
Subject of Research: Subclinical cardiac involvement in primary Sjögren syndrome detected by cardiac magnetic resonance imaging
Article Title: Cardiac involvement in primary Sjögren Syndrome patients and its association with disease activity: a cardiac magnetic resonance study
Article References: Liu, Q., Shi, T., Ouyang, T., Lu, Q., Guo, X., Wen, X., Meng, J., & Yang, Q. (2026). Cardiac involvement in primary Sjögren Syndrome patients and its association with disease activity: a cardiac magnetic resonance study. BMC Rheumatology. https://doi.org/10.1186/s41927-026-00695-z
Image Credits: AI Generated
DOI: 10.1186/s41927-026-00695-z
Keywords: primary Sjögren syndrome, cardiac magnetic resonance, myocardial dysfunction, native T1 mapping, T2 mapping, ESSDAI, disease activity, rheumatoid factor, Raynaud phenomenon, autoimmune disease, left ventricular strain, BMC Rheumatology
News Source: Ophelia Keating. (October 28, 2026). Heart scans reveal hidden cardiac changes in asymptomatic Sjögren patients. Scienmag.
