Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

It is unclear if lung perfusion can predict response to lung volume reduction surgery (LVRS). To study the role of perfusion scintigraphy in patient selection for LVRS. We performed an intention-to-treat analysis of 1,045 of 1,218 patients enrolled in the National Emphysema Treatment Trial who were...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2010-10, Vol.182 (7), p.937-946
Main Authors: CHANDRA, Divay, LIPSON, David A, HOFFMAN, Eric A, HANSEN-FLASCHEN, John, SCIURBA, Frank C, DECAMP, Malcolm M, REILLY, John J, WASHKO, George R
Format: Article
Language:English
Subjects:
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
E. Lung Transplantation and Surgery
Emergency and intensive respiratory care
Emphysema
Enrollments
Exercise Tolerance
Female
Humans
Intensive care medicine
Intention to Treat Analysis
Kaplan-Meier Estimate
Male
Medical sciences
Middle Aged
Mortality
Patient Selection
Patients
Perfusion Imaging
Pneumonectomy
Pulmonary Emphysema - diagnostic imaging
Pulmonary Emphysema - surgery
Questionnaires
Scintigraphy
Surgery
Tomography
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Summary:It is unclear if lung perfusion can predict response to lung volume reduction surgery (LVRS). To study the role of perfusion scintigraphy in patient selection for LVRS. We performed an intention-to-treat analysis of 1,045 of 1,218 patients enrolled in the National Emphysema Treatment Trial who were non-high risk for LVRS and had complete perfusion scintigraphy results at baseline. The median follow-up was 6.0 years. Patients were classified as having upper or non-upper lobe-predominant emphysema on visual examination of the chest computed tomography and high or low exercise capacity on cardiopulmonary exercise testing at baseline. Low upper zone perfusion was defined as less than 20% of total lung perfusion distributed to the upper third of both lungs as measured on perfusion scintigraphy. Among 284 of 1,045 patients with upper lobe-predominant emphysema and low exercise capacity at baseline, the 202 with low upper zone perfusion had lower mortality with LVRS versus medical management (risk ratio [RR], 0.56; P = 0.008) unlike the remaining 82 with high perfusion where mortality was unchanged (RR, 0.97; P = 0.62). Similarly, among 404 of 1,045 patients with upper lobe-predominant emphysema and high exercise capacity, the 278 with low upper zone perfusion had lower mortality with LVRS (RR, 0.70; P = 0.02) unlike the remaining 126 with high perfusion (RR, 1.05; P = 1.00). Among the 357 patients with non-upper lobe-predominant emphysema (75 with low and 282 with high exercise capacity) there was no improvement in survival with LVRS and measurement of upper zone perfusion did not contribute new prognostic information. Compared with optimal medical management, LVRS reduces mortality in patients with upper lobe-predominant emphysema when there is low rather than high perfusion to the upper lung.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201001-0043oc