Pneumologie 2014; 68 - P83
DOI: 10.1055/s-0034-1367871

Effects of endoscopic lung volume reduction on right ventricular myocardial function in patients with advanced emphysema

C Pizarro 1, R Schueler 1, C Hammerstingl 1, J Kreuz 1, U Juergens 1, G Nickenig 1, D Skowasch 1
  • 1Universitäts-Klinikum Bonn

Background:

Endoscopic lung volume reduction (ELVR) using endobronchial valve implantation provides a minimally invasive, effective technique for patients with severe progressive and irreversible lung emphysema. However, its impact on right ventricular (RV) function is unknown. We therefore assessed the extent of global and regional RV dysfunction in patients undergoing ELVR by use of speckle tracking echocardiography based on RV deformation analysis and correlated the results with the clinical outcomes using exercise capacity testing and Nt-proBNP-levels.

Methods and results:

We enrolled 25 patients (62 ± 9.8yrs, 68% male) with severe emphysematous COPD that were scheduled for undergoing bronchoscopic lung volume reduction with endobronchial valves (Zephyr, PulmonX Inc.). Echocardiographic assessment was conducted the day previous to ELVR and six weeks thereafter. Pre- and postprocedural exercise measurement by Six-minute walk test (6MWT) was used for determining clinical responder status to ELVR, with a change in 6MWT distance ≥26 m indicating clinical responsiveness. 15/25 treated patients were clinical responder with an improvement in 6 MWT distance of 126.3 ± 67.5 m.

After ELVR, RV global longitudinal strain improved significantly in the responder group (-17. 9 ± 5.4% vs. -21.4 ± 5.2%, p = 0.049), whereas there was no significant difference in other parameters of RV function such as RV apical and medial longitudinal strain, TAPSE or mPAP; no significant effect was seen in non-responding patients. These results correlated with the pre- and postprocedural Nt-proBNP-levels showing a statistical trend towards a relevant postprocedural Nt-proBNP-decrease in the responder group (239.6 ± 344.6pg/ml vs. 90.3 ± 69.3pg/ml, p = 0.07).

Conclusions:

ELVR improved RV function in patients with advanced emphysema. RV global longitudinal strain seems to be the best index to detect RV alterations in these patients.