This may indicate that cardiac alterations linked to sickle cell disease worsen with age, and this might need further wide-scale studies [52].The tissue Doppler echocardiographic-derived left ventricular MPI played an essential role in the present study in reflecting the process of myocardial fibrosis through its relation to the extracellular volume and serum level of galectin-3. This evidence concerns the gene LGALS3 and Myocardial fibrosis.