Abstract
One of the most common forms of pulmonary hypertension (PH) is the one associated with chronic obstructive pulmonary disease (COPD) and it is associated with worse prognosis. So far patients with severe emphysema and established PH have been excluded from endoscopic lung volume reduction (ELVR) therapy.
Objective: Whether ELVR achieved with one way endobronchial valve (EBV) placement influences in anyway the severity of PH in this specific group of patients.
Methods:Single-center case series study; 6 patients with severe heterogeneous emphysema and established PH were prospectively included. ELVR with unilateral EBV-placement was performed. Patients were assessed at baseline and 90 days post procedure.
Results:This pilot study was not powered to measure any statistical differences in endpoints. At 90 days post ELVR pulmonary function test (PFT) tended to improve and so did 6-minute walking distance +59±99meters; in right heart catheterization (RHC) mean haemodynamics also improved: mean pulmonary artery pressure -2.5±3.5mmHg, pulmonary arterial wedge pressure -4.4±8.3mmHg, pulmonary vascular resistance -61±158dynes*s*cm-5, cardiac index +0.3±0.6l/min/m2; Right atrial (RA) size measured by echo decreased and right ventricular size and the tricuspid annular plane systolic excursion (TAPSE) remained the same. ELVR was performed without PH-related complications in all patients.
Conclusion: ELVR in this case series was safe and feasible in patients with PH. We did not observe a deterioration of the pulmonary and systemic circulation. Further larger-scaled invasive studies are encouraged to examine cardiopulmonary interaction in ELVR.
- © 2014 ERS
