Left ventricular non-compaction in identical twins with thalassaemia and cardiac iron overload

Cardiac disease in patients with transfusion-dependent beta-thalassaemia major is well described. Cardiac manifestations may include left ventricular wall thickening and both systolic and diastolic dysfunctions. We describe a group of family members, including a pair of identical twins, each of whom suffered from thalassaemia major requiring multiple transfusions. Cardiac magnetic resonance demonstrated myocardial iron overload, and impairment of systolic function. Echocardiography confirmed both significant left ventricular systolic and diastolic impairment, along with features consistent with left ventricular non-compaction. This finding has not been noted in association with thalassaemia-related cardiac disease before. We then review the cardiac manifestations which occur in association with thalassaemia major.