”Summary: Left ventricular heart failure in the setting of a preserved left ventricular ejection fraction constitutes up to 50% of heart failure, increases with age, is correlated with the presence of systemic hypertention and left ventricular hypertrophy, and has significant morbidity and mortality, approaching that of systolic heart failure. Predisposing conditions for DHF are older age, female gender, diabetes and obesity, arterial hypertension, and left ventricular (LV) hypertrophy. Diagnosis of heart failure with normal ejection fraction requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Diagnostic evidence of diastolic LV dysfunction can be obtained invasively (LV end-diastolic pressure 16 mmHg or mean pulmonary capillary wedge pressure 12 mmHg) or non-invasively by tissue Doppler, blood flow Doppler of mitral valve or pulmonary veins, and echo measures of LV mass index or left atrial volume index. The study has included 50 patients with symptoms suggestive of congestive heart failure and coronary artery disease (typical exertional angma and positive exercise stress test, previous coronary brangiography, or history of myocardial infarction) scheduled for left sided heart catheterization. 113 Results: Magnetic resonance imaging (MRI) had the upper hand in evaluate all rheumatoid arthritis findings at early and established rheumatoid arthritis course (synovial thickening, increased vascularity, erosion and tendon abnormalities) and the bone marrow edema and bone cyst were detected only by magnetic resonance imaging, however ultrasonography (US) had high sensitivity, specificity and agreement with magnetic resonance imaging and even higher sensitivity in detection joint effusion. Both magnetic resonance imaging and ultrasonography had great role and comparable results in follow up and monitoring rheumatoid arthritis patients under anti-rheumatic drugs. By Chi-sqaure and P value, the synovial thickening and bone erosion was significant associated with increased vascularity by magnetic resonance imaging and ultrasonography but no association between synovial thickening and bone erosion. Bone erosion was highly associated with bone marrow edema.Conclusion: Ultrasonography findings of the hand and wrist joints in rheumatoid arthritis patients were comparable to magnetic resonance imaging findings which considered the gold standard for diagnosis.