The present study revealed a high prevalence of SSD in TA patients. Assessment of SSD by echocardiography combined with the GLS technique showed higher sensitivity than the conventional method of quantifying LVEF. In addition, the study demonstrated an association between disease activity and early myocardial dysfunction.

Similar to TA, cardiac dysfunction has been associated with inflammatory activity in other autoimmune diseases. For example, a Chinese study examining ninety-seven patients with systemic lupus erythematosus (SLE) found a positive association between SSD diagnosed using echocardiography with GLS and systemic lupus erythematosus disease activity index (SLEDAI) score ≥ 4 [6].

SSD in the TA is multifactorial. The high prevalence in our series, compared to the 7–20% prevalence reported in the literature, may be related to valvular insufficiency, which occurred in 53% of the patients [12]. Other factors, such as an inflammatory process in the myocardial tissue and/or conduction system, contribute to systolic dysfunction in this population, in addition to accelerated atherosclerosis [13]. Disease activity was associated with SSD. The greater the activity, the greater the damage to the myocardium. This can be explained by vasculitis activity, which leads to myocardial fibrosis and ventricular remodeling [13].

Comparing the groups with and without GLS >  − 20%, it was observed that patients with reduced GLS had a shorter disease duration, which shows that subclinical cardiac damage may be present in the first years of the disease. This finding corroborates the importance of a screening method for this condition in TA, promoting rapid recognition and prevention of adverse progression.

The limitations of this study include the small sample size, as it was conducted at a single center. Therefore, our results should be validated in a multicenter cohort study. In addition, echocardiogram with GLS is a subjective test that may vary with examiners. The ITAS-2010 score is an imminent clinical index that considers the subjective assessment of recent symptoms associated with TA and has a limited ability to accurately assess disease activity.

In autoimmune diseases, a reduction in GLS may be associated with unfavorable outcomes and a negative impact on life expectancy [14]. Therefore, it is recommended to perform cardiac evaluation in patients with TA using this technique to detect early myocardial dysfunction. This would help in preventing morbidity and mortality through therapeutic optimization.