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Objective: The aim of this study was to determine the frequency and the causes of left ventricular systolic dysfunction (LVSD) in systemic sclerosis (SSc) patients. Methods: SSc patients admitted to the Rheumatology Department of Faculty of Medicine, Hacettepe University between January 2015 and February 2017 were included in the study. The echocardiographic results of the patients were evaluated retrospectively and a left ventricular ejection fraction (LVEF) of <50% was defined as LVSD. Demographic and clinical characteristics of patients with and without LVSD were compared. Results: Two hundred and sixty-two (female/male: 240/22) SSc patients were included. Diffuse SSc was present in 65 (24.8%) patients. Eight (3.1%) patients had LVSD. No significant difference was found between patients with and without LVSD in terms of gender, disease duration, disease type, autoantibody specifity and the frequency of interstitial lung disease and/or pulmonary arterial hypertension; however, patients with LVSD were older (p=0.02) and had coronary artery disease (CAD) more frequently (p<0.001). In three patients, the cause of LVSD was coronary artery disease, and the age at diagnosis of LVSD in these patients was higher than patients without CAD (p=0.03). Results of cardiac magnetic resonance imaging were available in 4 of SSc patients with LVSD and revealed myocardial involvement of SSc in 2 patients. Conclusion: In this study, the frequency of LVSD in SSc patients was consistent with the literature. Microvascular ischemia and CAD may play a role in the etiology of LVSD in patients with SSc and especially elderly patients should be evaluated carefully for the presence of CAD. [ABSTRACT FROM AUTHOR]