A new perspective on cardiotoxicity of 5-fluorouracil. A novel research tool 'cardiac ultrasonic integrated backscatter analysis' indicates transient, subclinical myocardial dysfunction due to high-dose leucovorin and infusional 5-fluorouracil regimen.
BACKGROUND
The pathophysiology of 5-fluorouracil (5-FU) cardiotoxicity is still controversial. The objective of this study was to assess the influence of high-dose leucovorin and infusional 5-FU regimen (HDLV5FU) on cardiac tissues.


METHODS
We monitored 28 patients (median age 68 years) under HDLV5FU chemotherapy with complete blood counts, cardiac enzymes, C-reactive protein, coagulation tests, Holter electrocardiogram, and conventional echocardiography. Cardiac ultrasonic tissue characterization with integrated backscatter (IBS) analysis was performed in the 16 last enrolled patients.


RESULTS
The magnitude of both anterior and posterior cardiac IBS values significantly decreased at the 48th hour of treatment compared to both 0th hour and day 15 (p < 0.003). Cardiac IBS values on the 15th day were not different from the 0th hour. Clinical cardiotoxicity was not observed and other monitored parameters did not change significantly in any patient (p > 0.5 for all).


CONCLUSIONS
Cardiac IBS analysis suggests that 5-FU might cause reversible subclinical myocardial dysfunction.
Barutca
Sabri
S
Department of Medical Oncology, Adnan Menderes University Hospital, Aydin, Turkey. sbarutca@yahoo.com
Ceyhan
Ceyhun
C
Meydan
Nezih
N
Ozturk
Banu
B
Tekten
Tarkan
T
Onbasili
Alper
A
Kadikoylu
Gurhan
G
Bolaman
Zahit
Z
D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004452:Echocardiography / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects
D000964:Antimetabolites, Antineoplastic; D002955:Leucovorin; D005472:Fluorouracil