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Speckle-tracking echocardiography allows early detection of subclinical left ventricular systolic dysfunction (LVSD) in patients with rheumatoid arthritis (RA). In this prospective study, we assessed the prevalence and the prognostic role of subclinical LVSD detected by speckle-tracking echocardiography in RA patients.Two-dimensional global longitudinal strain (GLS) and global circumferential strain (GCS) were measured in 209 RA patients without overt cardiac disease. LVSD was defined as low GLS (> −16.0%), low GCS (> −17.8%), or both. The primary end point was all-causes hospitalization; the coprimary end point was hospitalization for cardiovascular causes.The study population had a mean age of 58 ± 11 years; 67% were female, 52% had hypertension, and the RA duration was 14 ± 10 years. Low GLS was detected in 51 patients (24%), low GCS in 42 patients (20%), and combined low GLS and GCS in 18 patients (9%). During a median follow-up time of 16 months (range, 10–21 months), a primary end point occurred in 50 patients (24%), and 25 patients were hospitalized for a cardiovascular event. Multiple Cox regression analyses revealed that combined low GLS and GCS was independently associated with the end point defined as all-causes hospitalization together with higher aortic stiffness. Examined individually, neither low GCS nor low GLS showed an independent association with this typology of clinical outcome. Conversely, both low GCS and low GLS (examined individually or as combined low GLS and GCS) emerged as strong independent prognosticators of cardiovascular events.Subclinical LVSD defined as low GLS, GCS, or both is common in RA patients without overt cardiac disease and provides additional prognostic information in these individuals.A significant proportion of asymptomatic rheumatoid arthritis patients without history of cardiac disease have subclinical left ventricular systolic dysfunction detected by speckle-tracking echocardiography and defined as low global longitudinal strain (GLS) and/or low global circumferential strain (GCS).In rheumatoid arthritis subjects analyzed in primary prevention, all-causes hospitalizations are independently related to the condition of combined low GLS and GCS.The combined low GLS and GCS status is characterized by older age, left ventricular diastolic dysfunction, and left ventricular hypertrophy, all of which are factors predisposing patients toward the development of overt heart failure.Low GCS, low GLS, and combined low GLS and GCS are strong independent predictors of cardiovascular events at mid-term follow-up.