Background: Systemic sclerosis (SS) is a chronic autoimmune disease characterized by widespread microvascular damage and fibrosis of skin and various internal organs. Myocardial fibrosis was reported in 50-80% of cases in necropsy series and accounts for a substantial portion of cardiac mortality. It may manifest as conduction system abnormalities, atrial and ventricular arrhythmias, biventricular cardiac failure or sudden death. Although various non-invasive methods may reveal functional abnormalities of both ventricles, these measurements are generally not specific. Myocardial biopsy may increase the frequency of detection of fibrosis, but is limited by its invasive nature and a high rate of sampling errors. Aim of the study: The aim of this study is to assess the prevalence of myocardial fibrosis as detected by Delayed enhanced magnetic resonance imaging (DE-MRI) in patients with systemic sclerosis and to evaluate a possible association between myocardial fibrosis, cardiac arrhythmias and other clinical findings such as pulmonary hypertension, skin thickness, Raynaud's phenomenon, pulmonary fibrosis and their relation to treatment and specific laboratory investigations (Anti-Scl 70). Patients and methods: Thirty patients with systemic sclerosis who fulfilled the criteria for scleroderma described by the Subcommittee For Scleroderma Criteria of the American College of Rheumatology (1980) as shown later, attending the Rheumatology and Rehabilitation Department, Kasr El-Aini Hospitals, Cairo University, were included in this work. Their ages ranged from 20 to 63 years with a mean of 41.5 years old. Results: the different positive modalities done to assess the cardiac abnormalities showed 60% with positive echo findings, 70% showed positive Holter abnormalities and 17% showed myocardial fibrosis in the DE-MRI. The main echo findings were valvular abnormalities (83%) and PHT (20%). The main Holter abnormalities were ventricular ectopic activity (30%) and supraventricular ectopic activity (17%). Concerning the pattern and distribution of the myocardial fibrosis, apical, midcavity and basal distribution affected 40% of total cases. The study showed a significant relation between +ve Holter, disease duration and cardiac manifestations. It also showed significant relation between +ve echo, disease duration and type of SSc. It was found a significant relation between +ve DE-MRI, age, disease duration and skin thickness. The correlation between the positive DE-MRI findings and different type of arrhythmias as premature ventricular contraction and premature atrial contraction was found to be significant. While the correlation between the three modalities were insignificant. Conclusion: Subclinical myocardial involvement, as detected by cardiac MRI, was frequent in asymptomatic patients with SSc. Cardiac MRI may aid in understanding the pathophysiological mechanism of SSc. The study demonstrates the potential of DE-MRI to define the pattern and prevalence of myocardial fibrosis in patients with SSc. MRI could potentially be used as a guide for myocardial biopsy or ablation studies. We strongly recommend performance of a Holter at least twice a year in patients with SSc. In SSc, echocardiography should be performed to achieve important information about left and right ventricular morphology and function, valvular function, and/or pericardial effusion.