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SSc with diffuse cutaneous involvement is defined as skin thickening proximal to the elbows\/knees, whereas the limited form denotes cutaneous involvement limited to the distal extremities. Pulmonary fibrosis, pulmonary hypertension, and cardiac inflammation\/fibrosis, although varying widely among patients in terms of severity, represent the main causes of death. Primary heart involvement occurs in the majority of patients at some disease stage but is overlooked. It may precede SSc diagnosis and should be carefully monitored using laboratory and imaging biomarkers. Among imaging biomarkers, echocardiography and cardiac magnetic resonance are the most commonly used. Echocardiography can provide functional information of both ventricles and assessment of pulmonary artery pressure. Additionally, strain echocardiography and cardiac magnetic resonance feature tracking can detect early systolic dysfunction before ejection fraction alterations take place. However, cardiac magnetic resonance, by providing functional assessment in parallel with tissue characterization, is the only imaging modality that has the potential to reveal early myocardial inflammation\/replacement\/diffuse fibrosis and coronary microvascular disease before any systolic alteration takes place. Prospective, multicenter studies that are currently under way will clarify the role of cardiac magnetic resonance in diagnosis, prognosis, and treatment decisions and will facilitate the conception of new imaging\u2010based guidelines for cardiac involvement in SSc.<\/jats:p>","DOI":"10.1161\/jaha.125.046400","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:51:56Z","timestamp":1785239516000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Imaging Modalities Related to Cardiac Involvement in Systemic Sclerosis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8192-6670","authenticated-orcid":false,"given":"George","family":"Markousis\u2010Mavrogenis","sequence":"first","affiliation":[{"name":"University of Heidelberg","place":["Germany"]},{"name":"Aghia Sophia Children\u2019s Hospital","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros P.","family":"Sfikakis","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens Medical School","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Matucci\u2010Cerinic","sequence":"additional","affiliation":[{"name":"IRCCS San Raffaele Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1089-7766","authenticated-orcid":false,"given":"Sophie I.","family":"Mavrogeni","sequence":"additional","affiliation":[{"name":"Aghia Sophia Children\u2019s Hospital","place":["Athens, Greece"]},{"name":"Athens Medical Center P. 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