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Introduction Preliminary findings suggest that elevated high-sensitivity cardiac troponin T (hs-cTnT) levels indicate cardiac involvement in systemic sclerosis (SSc). However, the association between longitudinal changes in hs-cTnT and long-term clinical outcomes remains unexplored.Objectives: We aimed to evaluate the association between longitudinal changes in hs-cTnT and cardiac outcomes in patients with SSc.Material and Methods We conducted a cohort study using data from the Scleroderma Clinic, Khon Kaen University, Thailand (2013-2023). Eligible patients were adults diagnosed with SSc who had at least two serial hs-cTnT measurements. Patients with advanced chronic kidney disease, prior coronary artery disease, or hyperCKemia were excluded. Patients were stratified into two groups based on hs-cTnT trends: stable or declining (n=143) versus rising over time (n=69). The primary outcome was a composite endpoint including cardiac death, clinical heart failure, or left ventricular systolic dysfunction. Cox proportional-hazards regression was used to assess associations between longitudinal hs-cTnT change and cardiac events.Results A total of 212 patients were analyzed. Patients with rising hs-cTnT levels had a significantly higher monthly rate of hs-cTnT change compared to the stable/declining group (15.5 vs. -4.6 ng/L/month, p<0.001), although baseline levels were lower in the rising group (12.3 vs. 21.3 ng/L, p<0.001). During a median follow-up of 7.8 years, 11 patients (5.1%) developed composite cardiac events. The incidence rate in patients with rising hs-cTnT group was significantly higher than in those with stable/declining group (p=0.045). In Cox regression analysis with cluster robustness within-subject correlation revealed that higher mRSS (adjusted HR range 1.07–1.09) and older age (adjusted HR range 0.87–0.88) were significant predictors of cardiac outcomes across models.Conclusions Rising hs-cTnT levels over time are associated with a significantly higher incidence of major cardiac events in patients with SSc. Serial monitoring of hs-cTnT may help identify patients at higher risk for adverse cardiac outcomes. Along with age and mRSS, longitudinal hs-cTnT monitoring is a valuable tool for predicting cardiac outcomes.Abstract P.137 Figure 1