Portal de Periódicos da CAPES

Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema

2019; Elsevier BV; Volume: 155; Issue: 5 Linguagem: Inglês

10.1016/j.chest.2019.02.012

1931-3543

Dirk‐Jan Slebos, Joseph Cicenia, Frank C. Sciurba, Gerard J. Criner, Jorine E. Hartman, Justin Garner, Gaëtan Deslée, Antoine Delage, Michael A. Jantz, Charles‐Hugo Marquette, Charlie Strange, Umur Hatipoğlu, Atul C. Mehta, Adam S. LaPrad, Gerald Schmid‐Bindert, Felix J.F. Herth, Pallav L. Shah, Felix J.F. Herth, Daniela Gompelmann, Maren Schuhmann, Robert T. Eberhardt, Dominik Harzheim, B. Rump, Dirk‐Jan Slebos, Nick ten Hacken, Karin Klooster, Jorine E. Hartman, Sonja W.S. Augustijn, Pallav L. Shah, Cielito Caneja, William McNulty, Justin Garner, Gaëtan Deslée, H. Vallerand, Sandra Dury, Delphine Gras, M. Verdier, Charles‐Hugo Marquette, C. Sanfiorenzo, Cathryn M. Clary, C. Leheron, J. Pradelli, Steven J. Korzeniewski, P. Wolter, T. S. Arfi, F. Macone, M. Poudenx, Sylvie Leroy, A. Guillemart, J. Griffonet, Charlie Strange, Rahul Argula, G. Silvestri, John T. Huggins, Nicholas J. Pastis, Donald W. Woodford, Lope Estévez Schwarz, David Walker, Gerard J. Criner, J. Mamary, Nathaniel Marchetti, Parth Desai, Kartik Shenoy, J.L. Garfield, John M. Travaline, H. Criner, S. Srivastava‐malhotra, Vanna Tauch, Roger A. Maxfield, Keith Brenner, William A. Bulman, Beth Whippo, Patricia Jellen, Ravi Kalhan, Colin T. Gillespie, Sharon R Rosenberg, Malcolm M. DeCamp, A.S. Rogowski, Juanita C. Hixon, Luis F. Angel, Osama Saber El Dib, Frank C. Sciurba, Divay Chandra, Mateus Crespo, Jessica Bon Field, John Tedrow, Carlos J. Ledezma, Paula Consolaro, Marie E. Beckner, Adnan Majid, Gillian Cheng, José Cárdenas-García, Douglas Beach, Erik Folch, A. Agnew, Wataru Hori, Arthur Nathanson, Momen M. Wahidi, Scott Shofer, Matthew G. Hartwig, Khalid Mahmood, Emily C. Smathers, William Tillis, K.K. Verma, Deepa Taneja, M. Peil, Subramanyam Chittivelu, P. Doloszycki, Patrick Whitten, B.S. Aulakh, O. Ikadios, Jonathan Michel, John W. Crabb, Bryan McVay, Andrew Scott, E.A. Pautler, Timothy A. Connolly, Jose F. Santacruz, Lisa Kopas, Rhian Parham, B. Solid, William Krimsky, Françoise Grégoire, Sinéad King, Atul C. Mehta, F. Almeida, Thomas R. Gildea, Joseph Cicenia, Michael Machuzak, Sonali Sethi, Yvonne Meli, Joanna Baran, Robert D. Rice, D. Faile, Navdeep Rai, Kurt Jensen, Richard Kahlstrom, Aasiya Haroon, Ramona Ionita, Fred White, David Watkins, B. Moore, Harmik J. Soukiasian, Heather E. Merry, Zab Mosenifar, Sara Ghandehari, David Balfe, Ji-Won Park, R. Mardirosian, J. Scott Ferguson, Jeffrey P. Kanne, David A. Sonetti, Dr.Jayprakash V.Modi, Meredith M. Regan, James D. Maloney, Mary E. Hackbarth, M.L. Gilles, Amanda Harris, Andrea Maser, Jonathan Puchalski, Carolyn L. Rochester, Jennifer D. Possick, Kara Johnson, Z. Dabre, Kevin L. Kovitz, M Joo, Joel A. DeLisa, Sharmila Vetri Villalan, Ganesh Krishna, James Canfield, Aditya Marfatia, E. Selley, Sharmila Vetri Villalan, James P. Utz, David E. Midthun, Ryan Kern, Eric S. Edell, L.L. Boras, Steven Gay, Kristy A. Bauman, MeiLan K. Han, Rommel Sagana, Kathy A Nelson, Cliff Meldrum, M. Jantz, Hiren J. Mehta, C. Eagan, Joseph West, Antoine Delage, Simon Martel, Pierre Leblanc, François Maltais, Y. Lacasse, Noël Lampron, Francis Laberge, Julie Milot, Josee Picard, Marie-Josée Breton, Mark T. Dransfield, J. Michael Wells, Surya P. Bhatt, Patrick J. Smith, E.N. Seabron‐harris, Kim Hammond, C. Egidio,

Pleural and Pulmonary Diseases

Background The Lung Volume Reduction Coil Treatment in Patients With Emphysema (RENEW) trial reported improvements in quality of life, pulmonary function, and exercise performance following endobronchial coil treatment. Objectives The purpose of this post hoc analysis was to identify baseline predictors, including quantitative CT measures, that identify patients most likely to significantly benefit from endobronchial coil therapy. Methods Quantitative CT analysis by an independent radiology laboratory and a qualitative evaluation by five blinded experts of the baseline thoracic CT imaging were performed. Univariate and multivariate logistic regression analyses were performed to elucidate characteristics associated with clinical response. Results In total, 125 patients underwent coil treatment and had evaluable 12-month follow-up results. Of these, 78 patients received treatment of lobes with the highest emphysematous destruction determined by quantitative CT analysis (quantitative visual match [QVM]+), and 47 received treatment in at least one lobe that was not the most destroyed (QVM–). From the 78 patients with QVM+ treatment, a subgroup of 50 patients (64%) was identified with baseline residual volume > 200% predicted, emphysema score > 20% low attenuation area, and absence of airway disease. In this subgroup, greater lobar residual volume reduction in the treated lobes was achieved, which was associated with significant mean ± SE improvement in FEV 1 (15.2 ± 3.1%), St. George's Respiratory Questionnaire (–12 ± 2 points), and residual volume (–0.57 ± 0.13 L). Discussion This post hoc analysis found that both significant hyperinflation (residual volume ≥ 200% predicted) and CT analysis are critical for patient selection and treatment planning for endobronchial coil therapy. Quantitative CT analysis is important to identify optimal lobar treatment and to exclude patients with insufficient emphysema (< 20% low attenuation area), whereas visual assessment identifies patients with signs of airway disease associated with worse outcomes. Trial Registry ClinicalTrials.gov; No.: NCT01608490; URL: www.clinicaltrials.gov.