Author + information
- Turhan Turan1,
- Mustafa Tarık Ağaç2,
- Ali Rıza Akyüz1,
- Selim Kul4,
- Faruk Boyacı5,
- Tayyar Gökdeniz2,
- Levent Korkmaz2,
- Hakan Erkan2,
- İlker Gül2,
- Ahmet Çağrı Aykan2 and
- Ramazan Akdemir3
5-Fluorouracil (5-FU) is a chemotherapeutic agent that is used for treatment of various solid malignancies. It is associated with significant cardiotoxicity through a mechanism similar to vasospastic angina. Heart-Type Fatty Acid Binding Protein (H-FABP) is a small unbound cytoplasmic protein that is present in high concentration in the myocardial cell and released into circulation within minutes of ischemia. Considering myocardial ischemia as the main mechanism of 5-FU cardiotoxicity, we aimed to assess the role of H-FABP in the early detection of 5-FU cardiotoxicity in addition to widely used echocardiographic techniques.
Thirty-two consecutive patients without history of cardiovascular disease receiving their first cycles of 5-FU based chemotherapy were included to the study. Twenty patients received a 15 min intravenous bolus infusion, while the remaining 12 patients received 24 h continuous infusion of 5-FU. Echocardiography was performed at baseline and following chemotherapy completion. Blood samples were collected for H-FABP and TnI analysis at baseline, at different time points during chemotheraphy infusion and following chemotheraphy completion (Figure 1).
Significant reduction in LVEF was observed following to 5-FU administration (59±6 % vs 57±5 %, p=0.004). There were no significant changes with regard to E, A, E/A ratio, E’ and A’ parameters following to 5-FU administration. However, there were significant prolongations in IVC and IVR times. E’/A’ ratio was significantly decreased, whereas no significant change was observed with regard to E/E’ ratio. TEI index was significantly increased (0.37±0.08 vs. 0.43±0.07, p<0.001) (Table 1). H-FABP and TnI levels were within normal ranges in all time points and no significant difference was observed in paired comparisons at any time points (Table 2).
Echocardiography may be helpful in early detection of subclinical cardiotoxicity following 5-FU administration. However, neither H-FABP nor TnI provided additional information regarding cardiotoxicity early after 5-FU infusion.
|Before 5-FU (n=32)||After 5-FU (n=32)||p value|
Abbreviations: A, late mitral filling velocity; A’, late diastolic myocardial velocity; E, early mitral filling velocity; E’, early diastolic myocardial velocity; ET, ejection time; FS, fractional shortening; IVCT, isovolumic contraction time; IVRT, isovolumic relaxation time; LVEF, left ventricle ejection fraction; NS, non-significant; TEI index, total ejection isovolumic index. *Data are expressed as mean ± standard deviations.
|T0 (Before 5-FU)||T1 (6th hour)||T2 (12th hour)||T3 (24th hour)||p value|
Abbreviations: H-FABP, heart-type fatty acid binding protein; NS, non-significant; TnI, Troponin I *Data are expressed as mean ± standard deviations.