Background: Chemotherapy cardiotoxicity is an emergingproblem and it is very important to prevent cardiacdysfunction caused by anticancer drugs. The aim of thisstudy was to assess the alterations of the cardiac functioninduced by chemotherapy in a follow-up of 2 years and toevaluate the cardioprotective role of angiotensin-convertingenzyme inhibitors (ACEIs) in the prevention of cardiacdysfunction.Methods: A prospective study was carried out usingpatients with breast cancer (85 women; median age57W12years) and other inclusion and exclusion criteria. Onthe basis of treatment, patients were divided into six groups:fluorouracil-epirubicincyclophosphamide, FEC (group A);FEC and trastuzumab (B); trastuzumab (C); FEC andtaxotere (D); FEC, paclitaxel and trastuzumab (E); andchemotherapy and cardioprotective drugs (F). Cardiologicalevaluation including electrocardiogram and conventionalechocardiogram with tissue Doppler imaging (TDI) wascarried out at T0 (before starting chemotherapy), T1 (after6months from the start of chemotherapy) and T2 (2 yearsafter the end of chemotherapy).Results: Significant changes in the TDI parameters ofsystolic and diastolic function were observed at T1 and T2 inall patients. A significant reduction of left ventricularejection fraction (LVEF) was observed only at T2.In the patients treated with ACEI (F), these changeswere less significant than in other groups and theydo not have significant changes in the indices of diastolicfunction.Conclusion: TDI is more sensitive than conventionalechocardiogram in the early diagnosis of cardiacdysfunction and ACEIs seem to have an important role in theprevention of cardiotoxicity.