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Objective: Systemic sclerosis(SSC)is a remarkably systemic heterogeneous connective tissue disease with many organs involved.The heart is one of the major organs involved,carrying the threat of sudden cardiac death,especially in diffuse cutaneous SSc.This review summarizes the pathophysiology,types,new diagnostic approaches,and imaging and novel therapies of primary cardiac complications while underlining the effects of recently developed non-contrast cardiovascular magnetic resonance(CMR)in early diagnosis.Data sources:Medline and Embase were searched for articles published up to July 2019.A combination of Medical Subject Headings(MeSH)terms and keywords pertaining to SSC(Scleroderma,Systemic OR Systemic sclerosis OR SSc),AND cardiology(cardiology OR heart OR cardiac)were applied to the search strategies.Study selection: Literature was mainly printed in English and Chinese about cardiac complications in systemic sclerosis.After selected simply on the title and abstract,the articles were included for the full text.Article type was not limited.Results: Relevant cardiac manifestations are complex,including arrhythmias,pericardial effusion,myocardial dysfunction,and valvular diseases.Even though the symptoms of cardiac complications are well known,unfortunately,they appear to be poor prognostic factors.As systemic sclerosis with cardiac complications has a high mortality rate and patients might have a poor quality of life,it is essential to promote early diagnosis and treatment.With the advent of non-invasive imaging techniques,such as CMR,early diagnosis of cardiac complications in SSC is becoming more effective.Conclusions: Cardiac complications play an essential role in SSC and carry the threat of sudden cardiac death.More basic and clinical studies are warranted to develop better management of cardiac involvement in patients with SSc.