Predicting Structure-Function Relations and Survival following Surgical and Bronchoscopic Lung Volume Reduction Treatment of Emphysema.
Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (bLVR) are palliative treatments aimed at reducing hyperinflation in advanced emphysema. Previous work has evaluated functional improvements and survival advantage for these techniques, although their effects on the micromechanical environment in the lung have yet to be determined. Here, we introduce a computational model to simulate a force-based destruction of elastic networks representing emphysema progression, which we use to track the response to lung volume reduction via LVRS and bLVR. We find that (1) LVRS efficacy can be predicted based on pre-surgical network structure; (2) macroscopic functional improvements following bLVR are related to microscopic changes in mechanical force heterogeneity; and (3) both techniques improve aspects of survival and quality of life influenced by lung compliance, albeit while accelerating disease progression. Our model predictions yield unique insights into the microscopic origins underlying emphysema progression before and after lung volume reduction.
Department of Biomedical Engineering, Boston University, Boston, MA, United States of America.|School of Medicine, Boston University, Boston, MA, United States of America.
Jarred R
JR
Mondoñedo
Department of Biomedical Engineering, Boston University, Boston, MA, United States of America.
Béla
0000-0002-9720-1006
B
Suki
D001999:Bronchoscopy / Q000401:mortality / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D003198:Computer Simulation; D004646:Emphysema / Q000401:mortality / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008954:Models, Biological; D017063:Outcome Assessment, Health Care / Q000379:methods; D011013:Pneumonectomy / Q000401:mortality* / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome