Purpose: In patients with aplastic anemia chronic iron overload due to multiple transfusion leads to symptoms of cardiac failure and it is the most frequent cause of death. The aim of this study was to find out the echocardiographic characteristics of aplastic anemia patients with chronic iron overload Methods: 33 patients (age 33짹10, M:F=14:19) with aplastic anemia who had received multiple blood transfusion during the course of disease and 15 age-matched subjects (age 34짹8, M:F=6:9) as a control group were recruited. The patients were divided into two groups: group A consisting of 22 patients with serum ferritin level ���2000 ng/ml, group B consisting of 11 patients with serum ferritin level < 2000 ng/ml. In these subjects, The conventional echocardiographic parameters including end-diastolic and end-systolic volume of left ventricle, LV EF(%), LV and RV wall thickness, LA dimension, myocardial performance index(Tei index) and LV filling indexes were measured and offline myocardial texture of recorded 2-D echocardiographic images was analyzed by two different cardiologists. Results: 1. 4 of 22 patients (18%) in group A showed LV EF < 45%. 2. LA dimension was 38.1짹4.4mm in group A and 32.2짹5.0mm in group B.(p<0.05 versus group A) 3. RV wall thickness were 4.4짹1.2mm in group A and 3.3짹0.6mm in group B.(p<0.05 versus group A) 4. There were no significant difference of LV wall thickness, LV filling indexes and myocardial performance index between group A and B. 5. Of the patients, the focal high echoreflectiveness, especially on interventricular septum and papillary muscle was more frequently observed compared to control group. Conclusion: The echocardiographic findings such as focal high echoreflectiveness, RV wall thickness and LA dilation might be the characteristics suggesting chronic iron overload due to multiple transfusion rather than the changes of LV filling patterns and LV wall thickness.