Key result
Fluoropyrimidine-based chemotherapy causes no significant 6-month changes in LVEF or GLS.
Why the study?
Fluoropyrimidine-based combination chemotherapy for gastrointestinal cancers may cause cardiotoxicity, motivating an assessment of its impact on echocardiographic left ventricular function.
Does fluoropyrimidine-based chemotherapy affect left ventricular function assessed in echocardiography at 6 months in patients with gastrointestinal cancer?
Observational (n=63)
No
Does fluoropyrimidine-based chemotherapy affect left ventricular function assessed in echocardiography at 6 months in patients with gastrointestinal cancer?
Answers are grounded in this paper and cite their sources.
Fluoropyrimidine-based chemotherapy was not associated with significant 6-month deterioration in serial echocardiographic LV systolic or diastolic function, but clinically relevant arrhythmic events still occurred, indicating that preserved LVEF and GLS do not exclude fluoropyrimidine-associated cardiotoxicity.
Background: Treatment of gastrointestinal cancers usually requires a combination of different chemotherapeutic drugs, predominantly fluoropyrimidines, which may result in cardiotoxicity. The main aim of the study was to assess the impact of chemotherapy on left ventricular function assessed in echocardiography. Methods: The single-center study included 63 patients [mean age of 66.4 (9.9) years, male (52.4%)], diagnosed with gastrointestinal cancer (colorectal cancer: n = 51, 81%). The most common chemotherapy regimen was FOLFOX 4 (oxaliplatin, 5-fluorouracil, levofolinic acid). Patients underwent echocardiography before the first cycle of chemotherapy and after a follow-up period of 6 months. In addition to standard echocardiographic parameters, left ventricular ejection fraction (LVEF) was measured using the 3D method and myocardial strain analysis was performed using the speckle-tracking technique (global longitudinal strain—GLS). Results: The mean LVEF of the study group was 58.9 (5.7)% and mean GLS was −17.2 (3.6)%. After the follow-up period, no statistically significant changes in LVEF, GLS, or diastolic function parameters were observed, irrespective of cancer type and chemotherapeutic drug. During follow-up, seven patients (11.1%) died due to the progression of cancer. Symptoms of possible fluoropyrimidine-induced cardiotoxicity (FIC) were observed in five cases, with cardiac arrhythmias being the most frequent manifestation (premature ventricular complexes, atrial fibrillation, and atrioventricular blocks). Conclusions: In this single-center study we showed that fluoropyrimidine-based chemotherapy was not associated with significant short-term deterioration in serial echocardiographic indices of LV systolic or diastolic function. However, clinically relevant cardiovascular events still occurred, underscoring that preserved LVEF and GLS do not exclude fluoropyrimidine-associated cardiovascular toxicity.
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Kazimierczyk et al. (2026) conducted an observational in Gastrointestinal cancer (81% colorectal cancer) undergoing fluoropyrimidine-based chemotherapy (n=63). Fluoropyrimidine-based chemotherapy (predominantly FOLFOX 4: oxaliplatin, 5-fluorouracil, levofolinic acid) vs. Baseline pre-chemotherapy status was evaluated on Changes in left ventricular function (3D LVEF, global longitudinal strain [GLS], and diastolic function parameters) and symptoms of fluoropyrimidine-induced cardiotoxicity. Fluoropyrimidine-based chemotherapy caused no significant 6-month change in LVEF or GLS, though possible cardiotoxicity symptoms occurred in 5 of 63 patients.
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