In our study we found a significantly low E′ velocity in lateral mitral annulus with high E/E′ ratio in all cancer survivors with significantly higher E/E′ ratio in abnormal NT-proBNP group and the group exposed to combined chemotherapy and radiotherapy which suggest the role of TDI and NT-proBNP in early detection of late cardiotoxicity in childhood cancer survivors exposed to anthracyclines and in particular when combined with mediastinal irradiation. Here, NPPB is linked to childhood malignant neoplasm.