title: Impact of endoscopic lung volume reduction on right ventricular myocardial function.
abstract: BACKGROUND
  Endoscopic lung volume reduction (ELVR) provides a minimally invasive therapy for patients with severe lung emphysema. As its impact on right ventricular (RtV) function is undefined, we examined the extent of RtV functional changes following ELVR, as assessed by use of speckle tracking-based RtV deformation analysis.
  
  
  METHODS
  We enrolled 32 patients with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr, PulmonX, Inc.), comprising 16 matched clinical responders and 16 non-responders. Echocardiography was conducted one day prior to ELVR and at an eight-week postprocedural interval.
  
  
  RESULTS
  Patients were predominantly of late middle-age (65.8 ± 8.7 yrs), male (62.5%) and presented advanced COPD emphysema (means FEV1 and RV: 32.6% and 239.1% of predicted, respectively). After ELVR, RtV apical longitudinal strain improved significantly in the total study cohort (-7.96 ± 7.02% vs. -13.35 ± 11.48%, p = 0.04), whereas there were no significant changes in other parameters of RtV function such as RtV global longitudinal strain, TAPSE or pulmonary arterial systolic pressure. In responding patients, 6MWT-improvement correlated with a decrease in NT-proBNP (Pearson´s r: -0.53, p = 0.03). However, clinical non-responders did not exhibit any RtV functional improvement.
  
  
  CONCLUSIONS
  ELVR beneficially impacts RtV functional parameters. Speckle tracking-based RtV apical longitudinal strain analysis allows early determination of RtV contractile gain and identification of clinical responsiveness.
authors: University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany.
authors: Carmen
authors: C
authors: Pizarro
authors: University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany.
authors: Robert
authors: R
authors: Schueler
authors: University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany.
authors: Christoph
authors: C
authors: Hammerstingl
authors: University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany.
authors: Izabela
authors: I
authors: Tuleta
authors: University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany.
authors: Georg
authors: G
authors: Nickenig
authors: University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany.
authors: Dirk
authors: D
authors: Skowasch
mesh_terms: D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011013:Pneumonectomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D011664:Pulmonary Valve; D018497:Ventricular Dysfunction, Right / Q000601:surgery*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain