International Journal of COPD (Oct 2022)

When Treatment of Pulmonary Emphysema with Endobronchial Valves Did Not Work: Evaluation of Quantitative CT Analysis and Pulmonary Function Tests Before and After Valve Explantation

  • Leppig JA,
  • Song L,
  • Voigt DC,
  • Feldhaus FW,
  • Ruwwe-Gloesenkamp C,
  • Saccomanno J,
  • Lassen-Schmidt BC,
  • Neumann K,
  • Leitner K,
  • Hubner RH,
  • Doellinger F

Journal volume & issue
Vol. Volume 17
pp. 2553 – 2566

Abstract

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Jonas Alexander Leppig,1 Lan Song,2 Dorothea C Voigt,1 Felix W Feldhaus,1 Christoph Ruwwe-Gloesenkamp,3 Jacopo Saccomanno,3 Bianca C Lassen-Schmidt,4 Konrad Neumann,5 Katja Leitner,6 Ralf H Hubner,3 Felix Doellinger1 1Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany; 2Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 3Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany; 4Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany; 5Institute of Biometrics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany; 6Department of Internal Medicine, Kantonsspital Aarau AG, Aarau, SwitzerlandCorrespondence: Jonas Alexander Leppig, Department of Radiology, Charité Universitätsmedizin Berlin, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany, Tel + 49 30 450 627 283, Fax + 49 30 450 527 911, Email [email protected]: To investigate changes in quantitative CT analysis (QCT) and pulmonary function tests (PFT) in pulmonary emphysema patients who required premature removal of endobronchial valves (EBV).Patients and Methods: Our hospital’s medical records listed 274 patients with high-grade COPD (GOLD stages 3 and 4) and pulmonary emphysema who were treated with EBV to reduce lung volume. Prior to intervention, a complete evaluation was performed that included quantitative computed tomography analysis (QCT) of scans acquired at full inspiration and full expiration, pulmonary function tests (PFT), and paraclinical findings (6-minute walking distance test (6MWDT) and quality of life questionnaires). In 41 of these 274 patients, EBV treatment was unsuccessful and the valves had to be removed for various reasons. A total of 10 of these 41 patients ventured a second attempt at EBV therapy and underwent complete reevaluation. In our retrospective study, results from three time points were compared: Before EBV implantation (BL), after EBV implantation (TP2), and after EBV explantation (TP3). QCT parameters included lung volume, total emphysema score (TES, ie, the emphysema index) and the 15th percentile of lung attenuation (P15) for the whole lung and each lobe separately. Differences in these parameters between inspiration and expiration were calculated (Vol. Diff (%), TES Diff (%), P15 Diff (%)). The results of PFT and further clinical tests were taken from the patient’s records.Results: We found persistent therapy effect in the target lobe even after valve explantation together with a compensatory hyperinflation of the rest of the lung. As a result of these two divergent effects, the volume of the total lung remained rather constant. Furthermore, there was a slight deterioration of the emphysema score for the whole lung, whereas the TES of the target lobe persistently improved.Conclusion: Interestingly, we found evidence that, contrary to our expectations, unsuccessful EBV therapy can have a persistent positive effect on target lobe QCT scores.Keywords: chronic obstructive pulmonary disease, pulmonary emphysema, endobronchial valves, lung volume reduction, computed tomography, pulmonary function test

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