OBJECTIVE To define the significance of myocardial remodeling and its association with the activity of an inflammatory process in systemic lupus erythematosus (SLE) and scleroderma systematica (SDS). METHODS One hundred and sixty-seven patients, including 102 with SLE and 65 with SDS, were examined. Intracardiac hemodynamic parameters were estimated by ultrasonography on an Acuson 128 XP/10 computed sonography system, by using 3.5-MHz frequency ultrasound transducers in accordance with the standard procedure recommended by the American Echocardiography Association (1987). The Systemic Lupus Activity Measurement (SLAM) and European Consensus Lupus Activity Measurement (ECLAM) scales were used to estimate the activity of SLE and its stages in SDS. RESULTS In patients with rheumatic diseases (RD), the spectrum of heart changes varied from latent diastolic dysfunction (DD) to the development of myocardial remodeling with signs of chronic heart failure. Examination of the types of myocardial remodeling in the patients with RD revealed all 4 geometric cardiac model types. There was a normal cardiac model in 59.2%, eccentric left ventricular (LV) hypertrophy in 18.4%, concentric hypertrophy in 19.5%, and concentric remodeling in 2.9%. In SLE, the disease activity determined the magnitude of LV hypertrophic processes (r = 0.57; p = 0.005) and DD (r = -0.43; p = 0.023). In the patients with SDS, the high activity was also associated with LV hypertrophy (r = 0.52; p = 0.015), but DD was primarily determined from the duration of disease (r = -0.44; p = 0.024). The patients with RD had LV DD no matter whether hypertension was present or absent. CONCLUSIONS There is evidence for myocardial remodeling and intracardiac hemodynamic disorders in SLE and SDS and their association with the activity of the process.