title: Collapse phenomenon during Chartis collateral ventilation assessment.
abstract: Chartis is increasingly used for bronchoscopic assessment of collateral ventilation before endobronchial valve (EBV) treatment for severe emphysema. Its prognostic value is, however, limited by the airway collapse phenomenon. The frequency and clinical significance of the collapse phenomenon remain largely unknown.We performed a retrospective analysis of 92 patients undergoing Chartis evaluation under spontaneous breathing (n=55) or jet ventilation (n=37) from May 2010 to November 2013. Collateral ventilation status (positive/negative/collapse phenomenon/unclear) was reassessed and correlated with high-resolution computed tomography (HRCT) fissure analysis and clinical response.In the absence of the collapse phenomenon, the predictive value of Chartis measurements and HRCT fissural analysis was comparable. The collapse phenomenon was observed in 31.5% of all assessments, and was more frequent in lower lobes (44.9% versus 16.9% in upper lobes) and under jet ventilation (41.4% versus 22.1% under spontaneous breathing). 69.8% of lobes with the collapse phenomenon had complete fissures. Most patients with the collapse phenomenon in the target lobe and complete fissures treated with EBVs were responders (n=11/15). All valve-treated collapse phenomenon patients with fissure defects were nonresponders (n=3).In the absence of the collapse phenomenon Chartis measurement is reliable to predict response to valve treatment. In patients with the collapse phenomenon, treatment decisions should be based on HRCT detection of fissure integrity. Chartis assessment should be performed under spontaneous breathing.
authors.affiliation: Klinik für Pneumologie, Asklepios Fachkliniken, Gauting, Comprehensive Pneumology Center Munich (CPC) and Member of the German Center for Lung Research (DZL), Germany These authors contributed equally to this work w.gesierich@asklepios.com.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gesierich
authors.affiliation: Klinik für Pneumologie, Asklepios Fachkliniken, Gauting, Comprehensive Pneumology Center Munich (CPC) and Member of the German Center for Lung Research (DZL), Germany 7th Respiratory Dept and Asthma Center, Athens Chest Hospital "Sotiria", Athens, Greece These authors contributed equally to this work.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Samitas
authors.affiliation: Klinik für Pneumologie, Asklepios Fachkliniken, Gauting, Comprehensive Pneumology Center Munich (CPC) and Member of the German Center for Lung Research (DZL), Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Reichenberger
authors.affiliation: Klinik für Pneumologie, Asklepios Fachkliniken, Gauting, Comprehensive Pneumology Center Munich (CPC) and Member of the German Center for Lung Research (DZL), Germany Dept of Internal Medicine V, University of Munich, Munich, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Behr
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000000981:diagnostic imaging; D001999:Bronchoscopy / Q000379:methods*; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011237:Predictive Value of Tests; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000628:therapy*; D012123:Pulmonary Ventilation; D015203:Reproducibility of Results; D012119:Respiration; D012129:Respiratory Function Tests / Q000295:instrumentation*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity