Background: beta-thalassemia major (beta-TM) is a congenital hemolytic disorder characterized by impaired left ventricular and endothelial function. However, elastic properties of the aorta have not been sufficiently investigated in patients with beta-TM. We investigated whether beta-TM is related to impaired ascending aortic elastic properties. Methods: We studied 36 patients with beta-TM (age: 15.8 +/- 2.6 years) and 30 age- and sex-matched control subjects by echocardiography. Aortic elastic indexes, aortic strain (%), distensibility (cm(2) dyn(-1) 10(-3)), and stiffness index were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), and the measurement of pulse pressure obtained by cuff sphygmomanometry. Results: Patients versus control subjects had increased aortic diameters (P < 0.001), lower mean aortic strain (9 +/- 3.6 vs. 14.9 +/- 3.2, P < 0.001) and distensibility (0.6 +/- 0.36 vs. 0.8 +/- 0.2, P < 0.012), and higher mean stiffness index (5.3 +/- 2.4 vs. 2.8 +/- 0.6, P < 0.001). Aortic elastic indexes were significantly associated with ferritin level, while stiffness index was significantly related to platelet count. Conclusion: Elastic properties of ascending aorta are impaired in patients with beta-TM. Impaired functions of aorta may lead to deterioration of left ventricular function.