Objective to investigate the clinical value of 2D spot tracking imaging (2D-STI) and real-time 3D echocardiography (RT-3DE) in evaluating left ventricular systolic synchronization in patients with active rheumatoid arthritis (RA) of different disease courses, and the correlation between the two methods in evaluating left ventricular systolic synchronization. Methods 90 patients with active RA were collected and divided into three groups according to the course of disease. The course of disease in group B was 5-10 years. The disease course of group C was more than 10 years and 30 healthy volunteers were selected as the control group. All subjects underwent routine echocardiography, 2D-STI, RT-3DE examination, and were analyzed by QLAB10.4 quantitative analysis software to obtain synchronization parameters: left ventricular longitudinal strain and circumferential strain reaching peak time standard deviation (Tls-SD, Tcs-SD), left ventricular 16-segment standard deviation (Tmsv-16-SD) and maximum time difference (Tmsv-16-Dif),the percentage of standard deviation (Tmsv-16-SD%) and the percentage of maximum difference (Tmsv-16-Dif%) of the time for the 16 segments of the left ventricle to reach the minimum systolic volume after R-R interval correction. Results Tmsv-16-SD, Tmsv-16-Dif, Tmsv-16-SD% and Tmsv-16-Dif% were gradually prolonged in group A, B and C compared with the control group, and the differences were statistically significant (P<0.05). Tls-SD and Tcs-SD were prolonged in group B and C compared with the control group, and the differences were statistically significant (P<0.05). The synchronization parameters Tls-SD and Tcs-SD were positively correlated with Tmsv-16-SD and Tmsv-16-Dif, respectively. The Intra-group correlation coefficient (ICC) analysis showed that 2D-STI and RT-3DE had good consistency in measuring left ventricular synchronization. Conclusion with the increase of the duration of disease, the left ventricular synchrony index of RA patients gradually lengthened, causing the left ventricular systolic dyssynchrony. Compared with conventional echocardiography, 2D-STI and RT-3DE could detect the changes of left ventricular synchrony in RA patients earlier, both of which could quantitatively evaluate the left ventricular systolic synchrony with good consistency.