Experimental Design: Using a cross-sectional design, anthracycline-exposed childhood cancer survivors with preserved ejection fraction (EF; -≥50%) were evaluated using early echocardiographic indices and blood biomarkers of LV dysfunction. Survivors treated with -≥300 mg/m2 anthracyclines [high risk (HR): n = 100] were compared with those treated with <300 mg/m2 anthracyclines [low risk (LR): n = 50] and matched healthy controls (HC: n = 50). All echocardiograms were interpreted by an institutional cardiologist and a study cardiologist blinded to risk status.