Objectives To study clinical and echocardiographic parameters in TDT patients, correlating these indices with T2*CMRI. To identify a deformational imaging metric in LMIC with severe TDT, to allow for early T2*CMRI. Background TDT requires lifelong transfusions, increasing the risk of multi organ dysfunction from iron toxicity. The problem is amplified in LMIC where access to resources maybe scarce, delaying timely chelation. T2* imaging is the gold standard to non-invasively estimate myocardial iron, to guide therapy. In resource constraints areas, we propose the use of Speckle Tracking Echocardiography (STE) to prioritize those with severe disease to obtain early T2* CMRI. Methods Twenty-five TDT patients who had undergone clinical, echocardiographic and CMRI evaluation were included in the study. Age matched controls with only echocardiographic data were recruited. Spearmans correlation was used to correlate echocardiographic indices of ventricular function and strain with T2*. Differences among patients with severe disease i.e. T2*<10 vs the remaining TDT group and controls was analyzed using Mann-Whitney U test. Results STE showed moderate inverse correlation with T2*CMRI for GLS and various indices of regional strain. GLS and regional strain were lower in patients with severe disease (T2* <10) when compared with normal controls and the rest of the TDT positive group (T2* >10) Conclusions Early decrease in GLS and regional strain, can serve as a useful tool to stratify those patients at risk of severe iron overload before systolic dysfunction ensues, serving as an adjunct in LMIC to prioritize T2* CMRI analysis for intensification of chelation therapy.