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Original Research: COPD |

Baseline Regional Perfusion Impacts Exercise Response to Endobronchial Valve Therapy in Advanced Pulmonary EmphysemaImpact of Perfusion on Endobronchial Valve Therapy

Rahul G. Argula, MBBS, MPH; Charlie Strange, MD, FCCP; Viswanathan Ramakrishnan, PhD; Jonathan Goldin, MD, PhD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Argula and Strange), the Division of Epidemiology and Biostatistics (Dr Ramakrishnan), Medical University of South Carolina, Charleston, SC; and the Department of Radiology (Dr Goldin), University of California, Los Angeles, CA.

Correspondence to: Rahul G. Argula, MBBS, MPH, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Ste 812 CSB, MSC 630, Charleston, SC 29425-6300; e-mail: argula@musc.edu


Part of this research was presented at CHEST 2011, on October 22-26, 2011, Honolulu, HI.

Funding/Support: The Endobronchial Valve for Emphysema Palliation Trial (VENT) was an industry-sponsored study funded by the maker of the Zephyr endobronchial valve, Emphasys Medical, Inc (now Pulmonx).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1578-1586. doi:10.1378/chest.12-2826
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Background:  Advanced heterogeneous emphysema with hyperinflation impacts exercise tolerance in COPD. Bronchoscopic lung volume reduction using Zephyr endobronchial valves (EBVs) has been shown to improve lung function in patients with heterogeneous emphysema. It is unclear whether the target lobe perfusion of patients receiving EBV therapy impacts exercise tolerance as measured by the 6-min walk test distance (6MWTD).

Methods:  We performed a retrospective analysis on the treatment group of the Endobronchial Valve for Emphysema Palliation Trial (VENT) to evaluate the impact of perfusion, measured by 99mTc-MAA-perfusion scintigraphy, on the 6-month improvement in 6MWTD. A mixed-model analysis was performed for the treatment outcome, adjusting for other variables such as age, target lobe position, fissure integrity, BMI, sex, destruction score, and lobar exclusion.

Results:  Dichotomized at the median, of the 169 patients who received EBV therapy, 88 had a low target lobe regional perfusion and 81 had high target lobe regional perfusion at baseline. Patients with a low target lobe regional perfusion had a significant improvement in 6MWTD when compared with those with a high baseline target lobe regional perfusion (30.24 m vs 3.72 m, P = .03). Shifts in perfusion after EBV therapy occurred only in patients with high baseline perfusion and did not correlate with improved 6MWTD.

Conclusions:  Patients having heterogeneous emphysema with a low baseline target lobe regional perfusion benefit from EBV therapy, independent of the degree of target lobe destruction. This effect is attenuated if the EBV therapy is not occlusive. Characterization of baseline perfusion may enhance clinical results of patients with emphysema undergoing EBV therapy.

Trial registry:  ClinicalTrials.gov; No.: NCT00000606; URL: www.clincialtrials.gov

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