Journal article
Physiological and Computed Tomographic Predictors of Outcome from Lung Volume Reduction Surgery
American journal of respiratory and critical care medicine, Vol.181(5), pp.494-500
03/01/2010
DOI: 10.1164/rccm.200906-0911OC
PMCID: PMC2830400
PMID: 19965810
Abstract
Rationale
: Previous investigations have identified several potential predictors of outcomes from lung volume reduction surgery (LVRS). A concern regarding these studies has been their small sample size, which may limit generalizability. We therefore sought to examine radiographic and physiologic predictors of surgical outcomes in a large, multicenter clinical investigation, the National Emphysema Treatment Trial.
Objectives
: To identify objective radiographic and physiological indices of lung disease that have prognostic value in subjects with chronic obstructive pulmonary disease being evaluated for LVRS.
Methods
: A subset of the subjects undergoing LVRS in the National Emphysema Treatment Trial underwent preoperative high-resolution computed tomographic (CT) scanning of the chest and measures of static lung recoil at total lung capacity (SR
tlc
) and inspiratory resistance (R
i
). The relationship between CT measures of emphysema, the ratio of upper to lower zone emphysema, CT measures of airway disease, SR
tlc
, R
i
, the ratio of residual volume to total lung capacity (RV/TLC), and both 6-month postoperative changes in FEV
1
and maximal exercise capacity were assessed.
Measurements and Main Results
: Physiological measures of lung elastic recoil and inspiratory resistance were not correlated with improvement in either the FEV
1
(
R
= −0.03,
P
= 0.78 and
R
= –0.17,
P
= 0.16, respectively) or maximal exercise capacity (
R
= –0.02,
P
= 0.83 and
R
= 0.08,
P
= 0.53, respectively). The RV/TLC ratio and CT measures of emphysema and its upper to lower zone ratio were only weakly predictive of postoperative changes in both the FEV
1
(
R
= 0.11,
P
= 0.01;
R
= 0.2,
P
< 0.0001; and
R
= 0.23,
P
< 0.0001, respectively) and maximal exercise capacity (
R
= 0.17,
P
= 0.0001;
R
= 0.15,
P
= 0.002; and
R
= 0.15,
P
= 0.002, respectively). CT assessments of airway disease were not predictive of change in FEV
1
or exercise capacity in this cohort.
Conclusions
: The RV/TLC ratio and CT measures of emphysema and its distribution are weak but statistically significant predictors of outcome after LVRS.
Details
- Title: Subtitle
- Physiological and Computed Tomographic Predictors of Outcome from Lung Volume Reduction Surgery
- Creators
- George R Washko - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsFernando J Martinez - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsEric A Hoffman - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsStephen H Loring - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsRaúl San José Estépar - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsAlejandro A Diaz - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsFrank C Sciurba - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsEdwin K Silverman - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsMeiLan K Han - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsMalcolm DeCamp - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsJohn J Reilly - Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.181(5), pp.494-500
- DOI
- 10.1164/rccm.200906-0911OC
- PMID
- 19965810
- PMCID
- PMC2830400
- NLM abbreviation
- Am J Respir Crit Care Med
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Publisher
- American Thoracic Society
- Language
- English
- Date published
- 03/01/2010
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
- Record Identifier
- 9984051785802771
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