Tipparot T, Foocharoen C, Mahakkanukrauh A, et al. - A cross-sectional study was carried out among 30 Thai adult systemic sclerosis (SSc) persons who had—disease onset < 4 years; a New York Heart Association functional class ≥ II; and followed up at the Scleroderma Clinic, Khon Kaen University, between June 2018 and January 2019 in order to determine the clinical and laboratory relationships with myocardial inflammation in SSc individuals as identified by cardiac MRI. The major proportion had diffuse cutaneous SSc. In 22 persons, myocardial inflammation was discovered. The multivariate analysis revealed that every 5 years of extended age at onset and every 5-point rise in the modified Rodnan skin score (mRSS) at onset was significantly related to myocardial inflammation. Neither the SSc subset, internal organ involvement, inflammatory markers, nor cardiac and muscle enzymes were related to myocardial inflammation in SSc. Thus, in early-onset SSc, myocardial inflammation is frequent. A heightened risk of myocardial inflammation was related to young age and high mRSS at the onset. Moreover, cardiac MRI is the recommended assessment for high-risk SSc persons encountering dyspnea on exertion.