With the development of the T2* technique [
83], and the black-blood sequence [
84], CMR has provided new insights into iron-overload cardiomyopathy, as the myocardial iron concentration [
85], prognosis [
86], and its toxic effect on ventricular function [
87], can be assessed at the same time with the same high-fidelity technique. Recent advances include identification of the lack of myocardial fibrosis [
88], the involvement of the right ventricle [
89], early strain abnormalities [
90], and improved prognosis [
91]. Combination therapy with deferoxamine and oral deferiprone is superior to deferoxamine alone in removing cardiac iron and improving left ventricular ejection fraction (LVEF). The right ventricle (RV) is also affected by the toxic effects of iron and may cause additional cardiovascular perturbation. In this study, the authors assessed the effects of combination therapy on the RV in thalassaemia major (TM) using CMR [
92]. In the RCT, combination therapy with deferoxamine and deferiprone was superior to deferoxamine alone for improving RVEF (3.6 vs 0.7%, p = 0.02). The increase in RVEF was greater with lower baseline T2* 8–12 ms (4.7 vs 0.5%, p = 0.01) than with T2* 12–20 ms (2.2 vs 0.8%, p = 0.47). In patients with severe cardiac siderosis, substantial improvement in RVEF was seen with open-label combination therapy (10.5% ± 5.6%, p < 0.01). Adding deferiprone to deferoxamine has beneficial effects on both RV and LV function in TM patients with cardiac siderosis.