title: Lung perfusion and emphysema distribution affect the outcome of endobronchial valve therapy.
abstract: The exclusion of collateral ventilation (CV) and other factors affect the clinical success of endoscopic lung volume reduction (ELVR). However, despite its benefits, the outcome of ELVR remains difficult to predict. We investigated whether clinical success could be predicted by emphysema distribution assessed by computed tomography scan and baseline perfusion assessed by perfusion scintigraphy. Data from 57 patients with no CV in the target lobe (TL) were retrospectively analyzed after ELVR with valves. Pulmonary function tests (PFT), St George's Respiratory Questionnaire (SGRQ), and 6-minute walk tests (6MWT) were performed on patients at baseline. The sample was grouped into high and low levels at the median of TL perfusion, ipsilateral nontarget lobe (INL) perfusion, and heterogeneity index (HI). These groups were analyzed for association with changes in outcome parameters from baseline to 3 months follow-up. Compared to baseline, patients showed significant improvements in PFT, SGRQ, and 6MWT (all P≤0.001). TL perfusion was not associated with changes in the outcome. High INL perfusion was significantly associated with increases in 6MWT (P=0.014), and high HI was associated with increases in forced expiratory volume in 1 second (FEV1), (P=0.012). Likewise, there were significant correlations for INL perfusion and improvement of 6MWT (r=0.35, P=0.03) and for HI and improvement in FEV1 (r=0.45, P=0.001). This study reveals new attributes that associate with positive outcomes for patient selection prior to ELVR. Patients with high perfusions in INL demonstrated greater improvements in 6MWT, while patients with high HI were more likely to respond in FEV1.
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine.
authors.forename: Christian
authors.initials: C
authors.lastname: Thomsen
authors.affiliation: Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Theilig
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine.
authors.forename: Dominik
authors.initials: D
authors.lastname: Herzog
authors.affiliation: Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Poellinger
authors.affiliation: Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Doellinger
authors.affiliation: Institute of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Schreiter
authors.affiliation: Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Schreiter
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schürmann
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine.
authors.forename: Bettina
authors.initials: B
authors.lastname: Temmesfeld-Wollbrueck
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hippenstiel
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine.
authors.forename: Norbert
authors.initials: N
authors.lastname: Suttorp
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine.
authors.forename: Ralf-Harto
authors.initials: RH
authors.lastname: Hubner
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000066491:Clinical Decision-Making; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055420:Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011652:Pulmonary Circulation; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014797:Vital Capacity; D000070857:Walk Test
keywords: COPD; emphysema distribution; endoscopic lung volume reduction; lung perfusion; valves