Objective: Endoscopic valve therapy aims at target lobe volume reduction (TLVR) that is associated with improved lung function, exercise tolerance and quality of life in emphysema patients. So far, a TLVR of >350 mL was considered to be indicative of a positive response to treatment. However, it is not really known what amount of TLVR is crucial following valve implantation. Patients and methods: TLVR, forced expiratory volume in 1 second (FEV1), residual volume (RV) and 6-minute walk distance (6-MWD) were assessed before and 3 months after valve implantation in 119 patients. TLVR was calculated based on computed tomography (CT) scan analysis using imaging software (Apollo; VIDA Diagnostics). Minimal important difference estimates were calculated by anchor-based and distribution-based methods. Results: Patients treated with valves experienced a mean change of 0.11 L in FEV1, -0.51 L in RV, 44 m in 6-MWD and a TLVR of 945 mL. Using a linear regression and receiver operating characteristic analysis based on two of three anchors (DeltaFEV1, DeltaRV), the estimated minimal important difference for TLVR was between 890 and 1,070 mL (ie, 49%-54% of the baseline TLV). Conclusion: In future, a TLVR between 49% and 54% of the baseline TLV, should be used when interpreting the clinical relevance.
- Gompelmann, D.
- Kontogianni, K.
- Schuhmann, M.
- Eberhardt, R.
- Heussel, C. P.
- Herth, F. J.
Keywords
- Bronchoscopy/adverse effects/*methods
- Exercise Tolerance
- Female
- Forced Expiratory Volume
- Humans
- Lung/diagnostic imaging/physiopathology/*surgery
- Male
- Middle Aged
- Minimal Clinically Important Difference
- Multidetector Computed Tomography
- Pulmonary Emphysema/diagnosis/physiopathology/psychology/*surgery
- Quality of Life
- Recovery of Function
- Residual Volume
- Retrospective Studies
- Time Factors
- Treatment Outcome
- Walk Test
- *emphysema
- *hyperinflation
- *target lobe volume reduction
- Boehringer Ingelheim, Novartis, Astra Zeneca, Munidpharma, Berlin Chemie and
- Grifols. MS obtained fees for lectures and advisory boards from the following
- companies: Olympus, Pulmonx, Astra Zeneca, Novartis, Teva, GSK, PneumRx and
- Boston Scientific. RE obtained lecture and travel fees from Olympus, Pulmonx and
- Uptake Medical. CPH has stock ownership in medical industry: Stada, GSK
- Patents:
- Method and Device for Representing the Microstructure of the Lungs. IPC8 Class:
- AA61B5055FI, PAN: 20080208038, Inventors: W Schreiber, U Wolf, AW Scholz and CP
- Heussel
- consultation or other fees from Schering-Plough (2009, 2010), Pfizer
- (2008-2014), Basilea (2008-2010), Boehringer Ingelheim (2010-2014), Novartis
- (2010 and 2012), Roche (2010), Astellas (2011 and 2012), Gilead (2011-2014), MSD
- (2011-2013), Lilly (2011), Intermune (2013 and 2014) and Fresenius (2013 and
- 2014)
- expert testimony no
- research funding from Siemens (2012-2014), Pfizer
- (2012-2014), MeVis (2012 and 2013) and Boehringer Ingelheim (2015)
- lecture fees
- from Gilead (2008-2014), Essex (2008-2010), Schering-Plough (2008-2010),
- AstraZeneca (2008-2012), Lilly (2008, 2009 and 2012), Roche (2008 and 2009), MSD
- (2009-2014), Pfizer (2010-2014), Bracco (2010 and 2011), MEDA Pharma (2011),
- Intermune (2011-2014), Chiesi (2012), Siemens (2012), Covidien (2012), Pierre
- Fabre (2012), Boehringer Ingelheim (2012-2014), Grifols (2012) and Novartis (2013
- and 2014). FH obtained fees for lectures and advisory boards from Astra,
- Allmirall, Berlin Chemie, Boehringer, Roche, GSK, Pulmonx, BTG, Olypmus, PneumRx,
- Boston Scientific, Medupdate, Grifols, CSL Behring, Omniamed, Lilly, Novartis,
- Teva and Uptake and Vital Air. The authors report no other conflicts of interest
- in this work.
