Pepe A, et al. - In a large, multicentre cohort of thalassaemia major (TM) patients, it was investigated if male gender was associated with a higher risk of cardiac iron accumulation and fibrosis, heart dysfunction and complications, in order to optimize the timing in cardiac follow-up. Results of more than 20 years of follow-up revealed significantly higher risk of ventricular dysfunction, heart failure, arrhythmias, and cardiac complications among male patients. Intrinsically better tolerance for iron toxicity may be observed in female patients. For thalassaemia patients, annual cardiac evaluation was recommended by international guidelines. It is possible that female patients can be evaluated at longer intervals, thus reducing health costs.