Study objectives: To examine whether relative
hypoperfusion to the apical one third of the lungs as determined by
lung scintigraphy predicts a favorable functional outcome following
bilateral lung volume reduction surgery (LVRS).
Methods: We performed a retrospective analysis of 128
patients who underwent bilateral LVRS. An apical perfusion fraction
(AP%), defined as the percentage of total lung perfusion to the apical
one third of both lungs, was derived for each patient by quantitative
scintigraphy technique. Pulmonary function testing and 6-min walk test
(6MWT) data were obtained preoperatively and 3 to 6 months
Results: The mean (± SD)
improvement in FEV1 was 309 ± 240 mL, 209 ± 293 mL,
and 116 ± 224 mL for patients with an AP% of ≤ 10%, 11 to 20%,
and > 20%, respectively (p = 0.01, analysis of variance[
ANOVA]). The likelihood of experiencing an increase in
FEV1 ≥ 200 mL was 68% for those with an AP% ≤ 10%
but only 31% for those with an AP% > 20%. Preoperative and
postoperative 6MWT data were available for 109 of 128 patients.
Improvement was 250 ± 252 feet, 205 ± 299 feet, and 77 ± 200
feet for patients with AP% ≤ 10%, 11 to 20%, and > 20%,
respectively (p = 0.04, ANOVA). While 50% of those with an AP%≤
10% improved their 6MWT by ≥ 180 feet, only 21% of those with
an AP% > 20% did so.
retrospective analysis suggests that quantification of apical perfusion
by nuclear scintigraphy assists in predicting the likelihood of
short-term functional improvement after LVRS.