Objective:

To assess cardiovascular safety and myocardial deformation after upadacitinib initiation in a real-world IMID cohort.

Approach:

• Study Design: A prospective, single-centre, exploratory observational study involving 36 adults with various immune-mediated inflammatory disorders initiating upadacitinib.
• Echocardiography Assessment: Transthoracic echocardiography with speckle-tracking global longitudinal strain (GLS) was performed at baseline, 1, 3, and 6 months.
• Data Analysis: Longitudinal changes were analyzed using rank-based repeated-measures models.

Key Findings:

• Baseline left ventricular ejection fraction (LVEF) was preserved (median 56.0%, IQR 55.0–61.0).
• GLS suggested subclinical myocardial dysfunction (−18.4%, IQR −19.8 to −16.2).
• No significant longitudinal changes were observed in LVEF (p=0.789), left ventricular mass index, relative wall thickness, or epicardial fat thickness.
• GLS showed a significant overall time effect (p=0.003) with a favorable trajectory at 1 month (p=0.003), sustained at 3 months (p=0.007) and 6 months (p=0.007).
• E/e′ increased modestly at 6 months (p=0.008) without structural remodelling.

Interpretation:

Limitations:

• Small sample size of 36 patients.
• Single-centre study may limit generalizability.
• Requires confirmation in larger controlled studies.

Conclusion: