Reduction of Lung Hyperinflation Improves Cardiac Preload, Contractility, and Output in Emphysema: A Clinical Trial in Patients Who Received Endobronchial Valves

Molen, Marieke C van der; Hartman, Jorine E.; Vanfleteren, Lowie E.G.W.; Kerstjens, Huib A. M.; Melle, Joost P. van; Willems, Tineke P.; Slebos, Dirk‐Jan

doi:10.1164/rccm.202201-0214oc

Cited by 22 publications

(13 citation statements)

References 36 publications

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“…Another study that evaluated cardiac hemodynamics pre and post-EBV placement in 24 patients showed significant improvements in right ventricle end-diastolic volume index, cardiac output, stroke volume, ejection fraction, and strain measurements. Conversely, there was no change noted in pulmonary artery pressures [32]. This study stresses the multifaceted physiology of dyspnea in patients with emphysema and calls for additional studies that assess pulmonary mechanics and hemodynamics postlung volume reduction and the presence of PH should not be considered as an absolute contra-indication.…”

Section: Patient Selectionmentioning

confidence: 65%

Bronchoscopic lung volume reduction in emphysema: a review

Ravikumar,

Wagh,

Holden

et al. 2023

Current Opinion in Pulmonary Medicine

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Purpose of review Chronic obstructive pulmonary disease (COPD) poses a substantial burden on the healthcare system and is currently considered the sixth leading cause of death in the United States. Emphysema, as evidenced by severe air-trapping in patients with COPD, leads to significant dyspnea and morbidity. Lung volume reduction via surgery or minimally invasive endobronchial interventions are currently available, which improve lung function and quality of life. Recent findings Newer studies have noted a survival benefit in patients post bronchoscopic lung volume reduction vs. those subjected to standard of care. The presence of collateral ventilation is one of the most common impeding factors to placing endobronchial valves, and if placed, these patients might not achieve lobar atelectasis; however, there are newer modalities that are now available for patients with collateral ventilation which we have described. Summary Combining standard of care treatment that includes smoking cessation, bronchodilators, preventive care including vaccinations, pulmonary rehabilitation, and endobronchial treatment using various interventions in decreasing hyperinflation improves quality of life and may improve survival and hence significantly reduce the burden of COPD on healthcare.

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Section: Patient Selectionmentioning

confidence: 65%

Bronchoscopic lung volume reduction in emphysema: a review

Ravikumar,

Wagh,

Holden

et al. 2023

Current Opinion in Pulmonary Medicine

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“…Hyperinflated lungs of severe emphysematous patients have shown to be associated with intrathoracic hypovolemia and decreased biventricular preload and reduced cardiac performance 35 . In a recent study 36▪▪ , in a cohort of 28 patients eligible for BLVR, MRI scans of the heart were performed before and after BLVR and revealed a significant and clinically relevant improvement of the right ventricular diastolic filling (primary outcome) and stroke volume, and even left ventricular stroke volume and ejection fraction, illustrating that BLVR is able to reverse the negative impacts of lung hyperinflation on the heart.…”

Section: Extrapulmonary Effects Of Lung Volume Reductionmentioning

confidence: 99%

Recent advances in bronchoscopic lung volume reduction for severe COPD patients

Posthuma,

Vaes,

Spruit

et al. 2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR. Recent findings For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression. Summary BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.

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“…An Australian study showed that twice weekly sessions for 8 weeks of telerehabilitation was broadly equivalent to face to face sessions in terms of exercise improvement but possibly inferior in improving breathlessness 59 . Meantime our understanding of endoscopic lung volume reduction (EVLR) grows with Swedish workers showing that cardiac preload, myocardial contractility and cardiac output all improved when pulmonary hyperinflation was decreased 60 . EVLR is less effective when collateral ventilation is present between lobes but Ing et al abolished this problem with endoscopic polymer foam placement before valve insertion leading to results comparable to patients with complete fissures between the lobes 61 thereby increasing the number of treatable patients.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Contemporary Concise Review 2022: Chronic obstructive pulmonary disease

Calverley

Walker

2023

Respirology

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International respiratory organizations now recommend using lower limit of normal and standardized residuals to diagnose airflow obstruction and COPD though using a fixed ratio <0.7 is simpler and robustly predicts important clinical outcomes.• The most common COPD comorbidities are coronary artery calcification, emphysema and bronchiectasis. COPD patients with psychological (high anxiety and depression) and cachectic (underweight and osteoporotic) comorbidity have higher mortality and exacerbate more. • Serum eosinophil count remains an important COPD biomarker and we have greater clarity about normal eosinophil levels in COPD and the wider population. • Criteria for entry into COPD clinical trials continue to exclude many patients, in particular those at greater risk of exacerbation and death. • The effect of hyperinflation on cardiac function impacts COPD mortality and is an important target for successful lung volume reduction procedures.

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Reduction of Lung Hyperinflation Improves Cardiac Preload, Contractility, and Output in Emphysema: A Clinical Trial in Patients Who Received Endobronchial Valves

Cited by 22 publications

References 36 publications

Bronchoscopic lung volume reduction in emphysema: a review

Bronchoscopic lung volume reduction in emphysema: a review

Recent advances in bronchoscopic lung volume reduction for severe COPD patients

Contemporary Concise Review 2022: Chronic obstructive pulmonary disease

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