0
Clinical Investigations: SURGERY |

Apical Perfusion Fraction as a Predictor of Short-term Functional Outcome Following Bilateral Lung Volume Reduction Surgery*

Robert M. Kotloff, MD, FCCP; John Hansen-Flaschen, MD, FCCP; David A. Lipson, MD; Gregory Tino, MD, FCCP; Selim M. Arcasoy, MD, FCCP; Abass Alavi, MD; Larry R. Kaiser, MD, FCCP
Author and Funding Information

*From the Pulmonary, Allergy, and Critical Care Division (Drs. Kotloff, Hansen-Flaschen, Lipson, Tino, and Arcasoy), Division of Nuclear Medicine (Dr. Alavi), and Division of Cardiothoracic Surgery (Dr. Kaiser), University of Pennsylvania Medical Center, Philadelphia, PA.

Correspondence to: Robert M. Kotloff, MD, FCCP, Pulmonary, Allergy, and Critical Care Division, 838 West Gates, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104; e-mail: kotloff@mail.med.upenn.edu



Chest. 2001;120(5):1609-1615. doi:10.1378/chest.120.5.1609
Text Size: A A A
Published online

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 postoperatively.

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.

Conclusion: This retrospective analysis suggests that quantification of apical perfusion by nuclear scintigraphy assists in predicting the likelihood of short-term functional improvement after LVRS.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Quantitation of Regional Ventilation During the Washout Phase of Lung Scintigraphy*: Measurement in Patients With Severe COPD Before and After Bilateral Lung Volume Reduction Surgery
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543