Cardiac Imaging Phenotypes in Systemic Inflammatory Disorders and Perspectives: What Have We Learned and Where Do We Need to Go Next?

Systemic autoimmune rheumatic diseases (SARDs) encompass a group of chronic, multisystem disorders characterized by immune-mediated tissue damage. Cardiovascular involvement in systemic autoimmune rheumatic diseases is common and contributes significantly to morbidity and mortality but is frequently subclinical and masked by other disease manifestations, making diagnosis challenging. Cardiac imaging plays a pivotal role in early detection, characterization, and monitoring of cardiovascular disease manifestations. This review discusses the cardiac imaging phenotypes associated with major systemic autoimmune rheumatic diseases, taking a pathophysiology-driven approach to appraise the role of echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and positron emission tomography. We discuss how these imaging modalities support the diagnosis and monitoring of suspected cardiovascular involvement in people with systemic autoimmune rheumatic diseases, identify gaps in current knowledge and highlight future directions in the integration of advanced imaging technologies.