title: Apical perfusion fraction as a predictor of short-term functional outcome following bilateral lung volume reduction surgery.
abstract: OBJECTIVE
  To examine whether relative hypoperfusion to the apical one third of the lungs as determined by lung scintigraphy predicts a favorable functional outcome following bilateral lung volume reduction surgery (LVRS).
  
  
  METHODS
  We performed a retrospective analysis of 128 patients who underwent bilateral LVRS. An apical perfusion fraction (AP%), defined as the percentage of total lung perfusion to the apical one third of both lungs, was derived for each patient by quantitative scintigraphy technique. Pulmonary function testing and 6-min walk test (6MWT) data were obtained preoperatively and 3 to 6 months postoperatively.
  
  
  RESULTS
  The mean (+/- SD) improvement in FEV(1) was 309 +/- 240 mL, 209 +/- 293 mL, and 116 +/- 224 mL for patients with an AP% of <or= 10%, 11 to 20%, and > 20%, respectively (p = 0.01, analysis of variance [ANOVA]). The likelihood of experiencing an increase in FEV(1) >or= 200 mL was 68% for those with an AP% <or= 10% but only 31% for those with an AP% > 20%. Preoperative and postoperative 6MWT data were available for 109 of 128 patients. Improvement was 250 +/- 252 feet, 205 +/- 299 feet, and 77 +/- 200 feet for patients with AP% <or= 10%, 11 to 20%, and > 20%, respectively (p = 0.04, ANOVA). While 50% of those with an AP% <or= 10% improved their 6MWT by >or= 180 feet, only 21% of those with an AP% > 20% did so.
  
  
  CONCLUSIONS
  This retrospective analysis suggests that quantification of apical perfusion by nuclear scintigraphy assists in predicting the likelihood of short-term functional improvement after LVRS.
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. kotloff@mail.med.upenn.edu
authors.forename: R M
authors.initials: RM
authors.lastname: Kotloff
authors.forename: J
authors.initials: J
authors.lastname: Hansen-Flaschen
authors.forename: D A
authors.initials: DA
authors.lastname: Lipson
authors.forename: G
authors.initials: G
authors.lastname: Tino
authors.forename: S M
authors.initials: SM
authors.lastname: Arcasoy
authors.forename: A
authors.initials: A
authors.lastname: Alavi
authors.forename: L R
authors.initials: LR
authors.lastname: Kaiser
mesh_terms: D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D016896:Treatment Outcome; D014692:Ventilation-Perfusion Ratio
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin