Wacker Annette, Lersch Christian, Scherpinski Ute, Reindl Laurence, Seyfarth Melchior
I. Medizinische Klinik und Deutsches Herzzentrum, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
Oncology. 2003;65(2):108-12. doi: 10.1159/000072334.
Angina pectoris, arrhythmic sudden death and myocardial infarction, all these cardiac events have occasionally been reported during 5-fluorouracil (5-FU) chemotherapy. Underlying mechanisms leading to these events are unknown; damage to the myocytes or vasospasms have been discussed.
102 consecutive and unselected patients were monitored with 12-lead ECG, echocardiography and radionuclide ventriculography prior to the first cycle of 5-FU chemotherapy and 3 months from baseline.
19% of the patients developed reversible symptoms of angina pectoris during treatment which lasted up to 12 h after cessation of the infusion. Most of the 19 patients showed corresponding ECG changes. 6 out of the 19 patients with severe angina pectoris had subsequent coronary angiography. In none of these patients the coronary angiography showed coronary artery disease, but it showed low ventricular function (ejection fraction <50%) in 2 patients. The ejection fraction did not increase over time. Arrhythmias were screened for with Holter monitoring during 5-FU chemotherapy. The frequency of bradycardia and ventricular extrasystoles increased significantly (p < 0.05) during treatment compared to arrhythmias in Holter monitoring 3 months later. Furthermore the Qtc time in the ECG 3 months later was significantly prolonged (p < 0.05) compared to baseline values.
The incidence of angina pectoris in patients during 5-FU treatment seems higher than previously suspected. As myocardial ischemia can be fatal, attentiveness to these symptoms and immediate treatment are crucial.
心绞痛、心律失常性猝死和心肌梗死，所有这些心脏事件偶尔在5-氟尿嘧啶（5-FU）化疗期间被报道。导致这些事件的潜在机制尚不清楚；已经讨论过对心肌细胞的损伤或血管痉挛。
102例连续且未经选择的患者在5-FU化疗的第一个周期之前以及从基线起3个月时接受12导联心电图、超声心动图和放射性核素心室造影监测。
19%的患者在治疗期间出现可逆性心绞痛症状，在输注停止后持续长达12小时。19例患者中的大多数出现了相应的心电图变化。19例严重心绞痛患者中有6例随后进行了冠状动脉造影。在这些患者中，冠状动脉造影均未显示冠状动脉疾病，但有2例显示心室功能低下（射血分数<50%）。射血分数未随时间增加。在5-FU化疗期间用动态心电图监测筛查心律失常。与3个月后的动态心电图监测中的心律失常相比，治疗期间心动过缓和室性期前收缩的频率显著增加（p<0.05）。此外，与基线值相比，3个月后的心电图中的Qtc时间显著延长（p<0.05）。
5-FU治疗期间患者心绞痛的发生率似乎高于先前的怀疑。由于心肌缺血可能是致命的，对这些症状的关注和及时治疗至关重要。
