PT  - JOURNAL ARTICLE
AU  - Christophe Pison
AU  - Adrien Jankowski
AU  - Sébastien Quétant
AU  - Marie Jondot
AU  - Cécile Chérion
AU  - Gilbert Ferretti
AU  - Wahju Aniwidyaningsih
TI  - Late-breaking abstract: Prevalence of emphysema heterogeneity measured with thoracic computed tomography soft in combination with collateral ventilation assessment to plan endoscopic volume reduction
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - p3526
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/p3526.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/p3526.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - Functional improvements after endoscopic volume reduction in severe emphysema were related to lobar heterogeneity and integrity of fissures in a post-hoc analysis of VENT data, NEJM 2010;363:1233. In 101 consecutive patients referred for endoscopic volume reduction, irrespective of CT findings, with FEV1 <50% pred. and in NHYA IV, we prospectively measured PFT's, arterial gases, % of lobar destruction as defined by the % of volume < -950 Hounsfield unit with Myriam, Intrasense, Paris, France and in patients with heterogeneous disease collateral ventilation with lobar balloon Chartis, Pulmonx, USA. Patients, 75 males, were 59.1±11.4 yr old, FEV1 29.1±9.8% pred., FVC 66.8±22.1%, TLC 146.5±23.4%, PaO2 8.84±1.5, PaCO2 5.5±1.22 kPa, KCO 39.6±20.6% pred., % of destruction was 30±17 in left upper lobe, 24±18 left lower lobe, 35±21 right upper lobe, 24±20 right middle lobe and 26±20 right lower lobe. In patients with severe emphysema, lobar heterogeneity defined by at least 1 lobe with > 50% destruction and a difference > 10% in destruction within lobes was found in 43 cases, 22 instances in left side, 31 right side, 15 both sides with no collateral ventilation in 83%. The first patients with no collateral ventilation treated with valves experienced major improvements in 80% in terms of FEV1, FVC and weight gain. We conclude that in patients with severe emphysema, heterogeneity was found in 43% of cases. From this single centre experience, endoscopic volume reduction seemed to result in meaningful improvements in 0.43x0.83x0.80 corresponding to 29% of cases. Funds from 2008-2010 innovative hospital grants.