+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Physiological and computed tomographic predictors of outcome from lung volume reduction surgery

Physiological and computed tomographic predictors of outcome from lung volume reduction surgery

American Journal of Respiratory and Critical Care Medicine 181(5): 494-500

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. 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. 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 (SRtlc) and inspiratory resistance (Ri). The relationship between CT measures of emphysema, the ratio of upper to lower zone emphysema, CT measures of airway disease, SRtlc, Ri, 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. 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. The RV/TLC ratio and CT measures of emphysema and its distribution are weak but statistically significant predictors of outcome after LVRS.

(PDF emailed within 0-6 h: $19.90)

Accession: 055001054

Download citation: RISBibTeXText

PMID: 19965810

DOI: 10.1164/rccm.200906-0911OC

Related references

Inspiratory and expiratory computed tomographic volumetry for lung volume reduction surgery. Interactive Cardiovascular and Thoracic Surgery 16(6): 926-928, 2013

Selection of patients for lung volume reduction surgery using a power law analysis of the computed tomographic scan. Thorax 58(6): 510-514, 2003

Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 57(6): 1173-82; Discussion 1173-82, 2005

Preoperative predictors of outcome following lung volume reduction surgery. Thorax 57 Suppl 2: Ii47-Ii52, 2002

Lung volume reduction surgery: preoperative functional predictors for postoperative outcome. Anesthesia and Analgesia 88(1): 28-33, 1999

Physiological heterogeneity is the best predictor of outcome after lung volume reduction surgery. Chest 118(4 Suppl ): 101S-102S, 2000

Advanced emphysema: preoperative chest radiographic findings as predictors of outcome following lung volume reduction surgery. Radiology 212(1): 49-55, 1999

Role of Quantitative Computed Tomographic Scan Analysis in Lung Volume Reduction for Emphysema. Respiration; International Review of Thoracic Diseases 2019: 1-9, 2019

Predictors of improvement in FEV1 (forced expiratory volume in 1s) after lung volume reduction surgery. Surgery Today 30(4): 328-332, 2000

Clinical and quantitative computed tomography predictors of response to endobronchial lung volume reduction therapy using coils. International Journal of Chronic Obstructive Pulmonary Disease 13: 2215-2223, 2019

Predictors of perioperative morbidity and mortality in lung volume reduction surgery. Annals of Thoracic Surgery 69(6): 1711-1716, 2000

Relationship between amount of lung resected and outcome after lung volume reduction surgery. Annals of Thoracic Surgery 69(2): 388-393, 2000

Computed tomographic-based volumetric reconstruction of the pulmonary system in scoliosis: trends in lung volume and lung volume asymmetry with spinal curve severity. Journal of Pediatric Orthopedics 27(6): 677-681, 2007

Relation between preoperative inspiratory lung resistance and the outcome of lung-volume-reduction surgery for emphysema. New England Journal of Medicine 338(17): 1181-1185, 1998

Short and long-term outcome of lung volume reduction surgery; role of lung scintigraphy. Journal of Nuclear Medicine 44(5 Supplement): 356P, 2003