Background <p>Epilepsy may affect cardiac function early due to seizure and pathophysiology-related autonomic changes. Strain echocardiography is a valuable method that reveals myocardial deformity with high sensitivity in these patients. This study aims to identify subclinical cardiac involvement in the epilepsy population using this method and to examine the contribution of the obtained data to cardiac risk assessment.</p> Methods <p>In this cross-sectional observational study, 49 epilepsy patients who underwent electroencephalography (EEG) examination, and 57 age and sex-matched healthy controls were examined. Standard transthoracic echocardiography (TTE) measurements, including tissue doppler indices, left and right ventricular global longitudinal strain (LVGLS, RVGLS), left atrial strain (LAS), and electrocardiography (ECG) parameters were compared between groups.</p> Results <p>Conventional systolic indices were partially preserved; however, patients with epilepsy exhibited significantly reduced LVGLS, RVGLS, and LAS values compared with controls (<i>p</i> &lt; 0.05). Some diastolic functions such as isovolumetric relaxation and contraction time and medial e′ velocities were significantly affected (<i>p</i> &lt; 0.05). ECG abnormalities, particularly conduction and repolarization disturbances, were more frequent in the epilepsy group. Notably, left ventricular ejection fraction (within normal range in both group) was significantly lower in epilepsy group, suggesting early systolic vulnerability.</p> Conclusion <p>Despite preserved some conventional echocardiographic findings, patients with epilepsy demonstrate significant subclinical myocardial deformation abnormalities detectable by strain imaging. Incorporation of speckle-tracking echocardiography into routine cardiovascular evaluation may facilitate early identification of myocardial involvement and improve cardiovascular risk stratification in this population.</p>