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Abstract:  Objective: To assess cardiac status in a large group of patients with thalassemia major who had been treated in a standard way since their early infancy with intensive transfusions and deferoxamine chelation therapy and who had good compliance with this regimen. Methods and Results: We assessed clinically and echocardiographically 202 thalassemia major patients aged 27.3 ± 6.3 yr and 75 age and sex‐matched healthy controls. Overt cardiac disease was encountered in 14 patients (6.9%), including 5 (2.5%) with congestive heart failure, aged 26–37 yr, and 9 with systolic left ventricular (LV) dysfunction, aged 23–37 yr. Ten patients (5.0%) had a history of pericarditis. Left atrial and LV diameters, LV mass and cardiac output were significantly higher in patients than in controls, while peripheral resistance and LV afterload were significantly lower. Relative LV wall thickness did not differ …