title: Lung Volume Reduction Surgery and Improvement of Endothelial Function and Blood Pressure in Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial.
abstract: BACKGROUND
  Cardiovascular disease is a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Preliminary studies have shown that both airflow obstruction and systemic inflammation may contribute to endothelial dysfunction in COPD. Lung volume reduction surgery (LVRS) is a treatment option in selected patients with COPD with emphysema that improves breathing mechanics and lung function.
  
  
  OBJECTIVE
  To determine the effect of LVRS on endothelial function and systemic inflammation.
  
  
  METHODS
  We conducted a randomized controlled trial in 30 patients scheduled for LVRS. In the intervention group, immediate LVRS was performed after baseline evaluation followed by reassessment 3 months later. In the control group, reassessment followed 3 months after baseline evaluation, and thereafter LVRS was performed.
  
  
  RESULTS
  The primary outcome measures were the treatment effect on endothelial function and systemic inflammation. In the LVRS group 14 patients completed the trial and 13 in the control group. LVRS led to a relative reduction in mean (SD) residual volume/total lung capacity of -12% (12%) and an increase in FEV1 of 29% (27%). Flow-mediated dilatation of the brachial artery increased in the intervention group as compared with the control group (+2.9%; 95% confidence interval, +2.1 to +3.6%; P < 0.001), whereas there was no significant change in systemic inflammation. A significant treatment effect on mean blood pressure was observed (-9.0 mm Hg; 95% confidence interval, -17.5 to -0.5; P = 0.039).
  
  
  CONCLUSIONS
  Endothelial function and blood pressure are improved 3 months after LVRS in patients with severe COPD and emphysema. LVRS may therefore have beneficial effects on cardiovascular outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT 01020344).
authors.affiliation: 1 Department of Pulmonology and.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Clarenbach
authors.affiliation: 1 Department of Pulmonology and.
authors.forename: Noriane A
authors.initials: NA
authors.lastname: Sievi
authors.affiliation: 1 Department of Pulmonology and.
authors.forename: Matthias
authors.initials: M
authors.lastname: Brock
authors.affiliation: 2 Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; and.
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.affiliation: 2 Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; and.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.affiliation: 1 Department of Pulmonology and.|3 Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Kohler
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000601:surgery*; D012129:Respiratory Function Tests
keywords: COPD; LVRS; cardiovascular disease; endothelial function