الفهرس 
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Abstract
Prediction of potential heart iron injury in TM patient was considered necessary in order to assess the efficacy of the treatment regimes, particularly the chelation therapy and to propose any modification. Echocardiography remains an indispensable tool in the cardiovascular assessment of patients, it provides many insights into cardiovascular function, and its use allows improved management of patients. It is particularly suited to assess diastolic function, diagnose intracardiac masses (usually thrombus), and assess right ventricular function and pulmonary pressure (John and Sunil, 2010).
The beginning and the timing of cardiac follow-up in patients with thalassemia depends on the transfusion and chelating history of individual patients. Patients must be referred to the consultant cardiologist with a report that provides a clear picture of their situation and possibly with a specific request (periodical check or emerging pathology).
For all of the previous we aimed to study the early detection of preclinical markers of left and right verticular dysfunction in patients with suspected myocardial iron overload specially in the absence of clinical signs of cardiac failure by echocardiography and its value in follow up of the patient.
Based on the results of the present study, the following could be concluded as:
1. As regard valvular lesions, mostly valvular regurgitation, usually of, trace, mild or moderate was higher in patients.
2. (PASP) was significantly higher in patients than in controls.
3. (LVED) diameter and LV end- systolic diameter were significantly increased in patients with beta thalassemia than controls.
4. (LA) diameter and (RVD) were significantly higher in patients than in controls.
5. (EF) was significantly higher in patients than in controls due to increase COP compensatory to anemia.
6. Cardiac chambers dilatation in (TI) patients was a compansatory mechanism for anemia and hypoxia so (RVD) and (LVED) diameter was significantly higher in (TI) patients than in (TM).
7. Significant negative correlation between hemoglobin and )EF( and also between (FS) and hemoglobin.
8. Significant negative Correlation between Serum Ferritin, (LV) End Diastolic Diameter.
9. Significant Positive correlation between age and pulmonary artery systolic pressure.
10. Significant positive Correlation between serum ferritin and liver enzymes (AST, ALT and ALP).
RECOMMENDATIONS
1. Regular follow up of the patients by clinical examination, CBC, liver functions, routine endocrine screening ,echocardiograpgy, ECG and MRI if possible.
2. Echocardiography remains a tool in the cardiovascular assessment of patients, it provides many insights into cardiovascular function, and its use allows improved management of patients. It is particularly suited to assess diastolic function, diagnose intracardiac masses (usually thrombus), and assess right ventricular function and pulmonary pressure so it should be included in the follow up scheme of the patients.
3. MRI is recommended for follow up of our patients and it should be included in further study because it allows the comparison of iron load to heart function. It is clear that cardiac damage is related to the amount of cardiac iron. MRI T2* provides the ability to determine the predictive value of ferritin, LIC, ECHO and BNP with respect to cardiac iron. It can also assess the impact of the patients’ compliance to therapy and their red cell consumption on cardiac iron. Finally it allows monitoring of the effect of the treatment modifications.
4. Strict monitoring of serum ferritin and decreasing body iron is essential because our results supported by previous retrospective, natural history, and prospective non randomized clinical trials, suggested that mortality, mainly due to cardiac damage, was reduced or completely absent in patients treated with iron chelating agents specially the new agents.
5. Strict monitoring of hemoglobin level keeping it above 9g/dl is recommended to avoid dangerous effects of hypoxia on the heart including chamber dilatation, decrease contractile function and increase pulmonary artery systolic pressure.
6. Serum troponin 1 was measgured for some patients so Strict monitoring of serum troponin1 for all patients, its relations to cardiac iron and cardiac functions is recommended. It should be included in further study to determine its value as a peridictive marker for iron over load in the heart.