RT Journal Article
SR Electronic
T1 Effects of endoscopic lung volume reduction on the distribution of pulmonary perfusion and ventilation
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P3715
VO 44
IS Suppl 58
A1 Carmen Pizarro
A1 Hojjat Ahmadzadehfar
A1 Markus Essler
A1 Izabela Tuleta
A1 Georg Nickenig
A1 Dirk Skowasch
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P3715.abstract
AB Introduction:Endoscopic lung volume reduction (ELVR) using endobronchial valves represents an established therapy for emphysematous COPD. However, any resulting changes in lung perfusion and ventilation remain unknown.Objectives:The aim was to investigate, by means of pulmonary scintigraphy, adaptations in lung perfusion and ventilation that follow ELVR.Methods:We enrolled 19 patients (65±8.7yrs, 60.9% male) with COPD heterogeneous emphysema undergoing ELVR with endobronchial valves (Zephyr®, PulmonX Inc.). Mean baseline FEV1 and RV were 33.1% and 253.2% predicted, respectively. Baseline 6 min. walk test distance (6MWD) was 289.1±126.1 m. Ventilation/perfusion lung scintigraphy was conducted prior to ELVR and six weeks thereafter. Pre- and post-procedural analyses of regional and whole lung perfusion and ventilation shifts were performed and complemented by correlation measurements (Spearman's rho) between paired analyzed lobes.Results:After ELVR, the target lobe perfusion showed a mean reduction of 6.8% (p<0.0001) and was significantly associated with a simultaneous perfusion decrease in the ipsilateral, non-treated lobe (rho=0.49, p=0.017). Ventilation of the emphysematous target lobe was also reduced (p=0.009) and correlated proportionally with the correspondent perfusional adaptations (rho=0.54). Contralateral whole lung perfusion exhibited a significant increase post-ELVR (p=0.027). These effects occurred independently of clinical responsiveness to ELVR, stated by changes in 6MWD.Conclusions:ELVR induces a relevant reduction in perfusion and ventilation of the treated lobe that corresponds with compensatory perfusional increases in the contralateral lung.