Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Mar 30;10(3):e0118976.
doi: 10.1371/journal.pone.0118976. eCollection 2015.

Effect of endobronchial valve therapy on pulmonary perfusion and ventilation distribution

Carmen Pizarro  1 , Hojjat Ahmadzadehfar  2 , Markus Essler  2 , Izabela Tuleta  1 , Rolf Fimmers  3 , Georg Nickenig  1 , Dirk Skowasch  1
Affiliations
Observational Study

Effect of endobronchial valve therapy on pulmonary perfusion and ventilation distribution

Carmen Pizarro et al. PLoS One. .

Abstract

Introduction: Endoscopic lung volume reduction (ELVR) is an emerging therapy for emphysematous COPD. However, any resulting changes in lung perfusion and ventilation remain undetermined. Here, we report ELVR-mediated adaptations in lung perfusion and ventilation, as investigated by means of pulmonary scintigraphy.

Methods: In this observational study, we enrolled 26 patients (64.9 ± 9.4 yrs, 57.7% male) with COPD heterogeneous emphysema undergoing ELVR with endobronchial valves (Zephyr, Pulmonx, Inc.). Mean baseline FEV1 and RV were 32.9% and 253.8% predicted, respectively. Lung scintigraphy was conducted prior to ELVR and eight weeks thereafter. Analyses of perfusion and ventilation shifts were performed and complemented by correlation analyses between paired zones.

Results: After ELVR, target zone perfusion showed a mean relative reduction of 43.32% (p<0.001), which was associated with a significant decrease in target zone ventilation (p<0.001). Perfusion of the contralateral untreated zone and of the contralateral total lung exhibited significant increases post-ELVR (p = 0.002 and p = 0.005, respectively); both correlated significantly with the corresponding target zone perfusion adaptations. Likewise, changes in target zone ventilation correlated significantly with ventilatory changes in the contralateral untreated zone and the total contralateral lung (Pearson's r: -0.42, p = 0.04 and Pearson's r: -0.42, p = 0.03, respectively). These effects were observed in case of clinical responsiveness to ELVR, as assessed by changes in the six-minute walk test distance.

Discussion: ELVR induces a relevant decrease in perfusion and ventilation of the treated zone with compensatory perfusional and ventilatory redistribution to the contralateral lung, primarily to the non-concordant, contralateral zone.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have read the journal´s policy and the authors of this manuscript have the following competing interests: Carmen Pizarro received funding from a commercial source (Pulmonx, Inc.). The other authors have no competing interests to declare. This does not alter the authors´ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Pulmonary scintigraphy with ventilatory (a) pre-procedural, b) post-procedural) and perfusional (c) pre-procedural, d) post-procedural) imaging in a left upper lobe treated patient.
Fig 2
Fig 2. Boxplot of ELVR-mediated changes in target zone perfusion and ventilation.
See this image and copyright information in PMC

References

    1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. (2007) Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176: 532–555. - PubMed
    1. Mannino DM, Buist AS (2007) Global burden of COPD: risk factors, prevalence, and future trends. Lancet 370: 765–773. - PubMed
    1. Martinez FJ, Chang A (2005) Surgical therapy for chronic obstructive pulmonary disease. Semin Respir Crit Care Med 26: 167–191. - PubMed
    1. Fishman A, Martinez F, Naunheim K, Piantadosi S, Wise R, Ries A, et al. (2003) A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 348: 2059–2073. - PubMed
    1. Naunheim KS, Wood DE, Mohsenifar Z, Sternberg AL, Criner GJ, DeCamp MM, et al. (2006) Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group. Ann Thorac Surg 82: 431–443. - PubMed

Publication types