Patients with MDS require regular red cell transfusion causingsecondary iron overload with multiple complications as cardiomyopathywhich worsen performance of life, survival. The aim of this work is tostudy side effects of multitransfusion and iron overload among adultMDS cases with special emphasis on cardiac performance and function.In this study a group of 20 adult MDS patients, and 15 age and sexmatched controls were included and subjected to: full history taking,clinical examination, CBC with ferrokinetic studies, liver and kidneyfunctions, echocardiography. MDS patients showed marked iron overload compared to controlgroup, also they study showed the role of iron overload in occurrence ofcardiomyopathy presenting with diastolic dysfunction with or withoutsystolic dysfunction.