Evaluation Of The Effects Of Fluorouracil Chemotherapeutic Drugs On Cardiovascular Structure And Function Using Ultrasound Technology

Background:Fluorouracil-based adjuvant chemotherapy regimens are the standard treatments for gastric and colorectal cancers for a long time,and improved the prognosis of patients effectively.However,with the extension of survival time of oncology patients,cardiovascular complications caused by fluorouracil-based drugs have become increasingly prominent.In this study,we applied echocardiography and brachial artery ultrasound techniques to assess the effects of fluorouracil-based chemotherapeutic agents on cardiac and vascular structure and function.Objectives:1 To investigate the effects of fluorouracil-based chemotherapy drugs on the structure and function of heart and brachial artery using ultrasound technology.2 To explore the ultrasound indicators for monitoring early cardiovascular damage associated with fluorouracil-based chemotherapy drugs.3 To explore the factors associated with fluorouracil-based cardiovascular damage.Methods:Patients with gastrointestinal malignancies who were hospitalized for the first time to receive adjuvant chemotherapy with fluorouracil-based agents were recruited for this study.Patients were divided into group G1(fluorouracil,capecitabine)and group G2(tegafur)according to chemotherapy regimens for follow-up analysis,defining cancer therapeutics-related cardiac dysfunction(CTRCD)as the primary endpoint event.Echocardiography and brachial artery ultrasound were performed at the same time as clinical data was collected before the start of chemotherapy and at the end of each cycle of chemotherapy.Results:A total of 90 patients with gastrointestinal malignancies were recruited in this study,and 51 patients finally met the enrollment criteria and completed 4 cycles of follow-up and analysis,including 31 patients in group G1 and 20 patients in group G2.There was no significant difference in clinical baseline data between the two groups(p>0.05).The echocardiographic and brachial artery ultrasound measurements were not significantly different between the G1 and G2 groups by the end of the 4th cycle of chemotherapy(p>0.05).High density lipoprotein cholesterol(HDL-C)and left atrial volume index(LAVI)were higher in both the G1 and G2 groups after 4 cycles of chemotherapy compared with baseline(p<0.05).The left ventricular global longitudinal strain(GLS),global longitudinal strain of epicardium(GLS-epi),global longitudinal strain of endocardium(GLS-endo)and left atrial strain during contraction phase(LAS-ct)were decreased compared with baseline in group G1(p<0.05).The left ventricular global longitudinal strain(GLS),global longitudinal strain of epicardium(GLS-epi)were decreased compared with baseline in group G2(p<0.05).There was no significant difference in myocardial work index,3D strain and flow-mediated vasodilation(FMD)before and after chemotherapy in both groups(p>0.05).A total of 6(11.8%)patients in the entire population experienced CTRCD during the entire follow-up period,4(12.9%)patients in group G1 and 2(10.0%)patients in group G2.The results of one-way COX regression analysis showed that the rate of change in left atrial ejection fraction after 1 cycle of chemotherapy(Tlv-LAEF)and the rate of change in left atrial strain during reservoir phase after 1 cycle of chemotherapy(Tlv-LASr)were associated with CTRCD[Tlv-LAEF(HR=1.040;95%confidence interval:1.000-1.082;p=0.047);Tlv-LASr(HR=1.024;95%confidence interval:1.000-1.048;p=0.048)].The area under curve(AUC)of Tlv-LAEF for predicting CTRCD was 0.694,with the sensitivity of 50.0%and specificity of 93.3%at the cut-off value of T1v-LAEF>19.68%,the AUC of Tlv-LASr for predicting CTRCD was 0.707,with the sensitivity of 66.7%and specificity of 75.6%at the cut-off value of Tlv-LASr>14.73%.Conclusion:1 There are differences in the cardiotoxicity among fluorouracil-based drugs,with a slightly lower incidence of CTRCD with tegafur chemotherapy compared to fluorouracil and capecitabine,no abnormal changes in brachial artery were found after chemotherapy.2 All fluorouracil-based drugs can cause changes in LVEF and GLS,and GLS changes in more patients with subclinical impairment of cardiac function.3 Fluorouracil-based drugs can affect the structure and function of the left atrium,Tlv-LAEF and Tlv-LASr are predictors of cardiac function damage.