Aims: To identify early heart failure in patients with thalassemia major by examining NT-pro-BNP and to correlate echocardiographic parameters. Materials and methods: We evaluated 37 consecutive patients with homozygous β-thalassemia and 50 age-matched healthy controls by NT-pro-BNP levels and echocardiography. Results: NT-proBNP levels weresignificantly higher in TM cohort compared to healthy controls 169.3±166.3 versus 33±19.5 pg/ml. (р<0.001). There were 11 (29.7%) patients with elevated NT-pro-BNP. Ultrasound and MRI LAVi (ml/m²) were significantly enlarged with borderline depression of left atrial emptying fraction. TM NT-proBNP+) had significantly larger left atrial volume index LAVi(p=0.025) compared to TM NT-proBNP-, but all other indices were no different. There was a moderate yet significant correlation between NT-pro-BNP and LAVi – r=0.44, p=0.009 and between LVMMi and LAVi- r = 0.480, p= 0.004. Conclusions: The only significant difference between the two TM groups - NT-proBNP positive and NT-proBNP negative was left atrial volume index LAVi.