Anthracyclines are important anticancer drugs, but their use is limited by acute and chronic cardiotoxicity. Current approaches to surveillance are often inadequate to detect myocardial disease. Strain imaging might detect earlier myocardial dysfunction. Speckle analysis of three-dimensional (3D) echocardiography improves information about left ventricular (LV) segmental and global deformation by avoiding the loss of speckles seen in monoplane bidimensional-strain analysis. We assessed whether early 3D-strain analysis could predict later anthracycline-induced cardiotoxicity.