Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema.
Aged
Analysis of Variance
Bronchoscopy
/ instrumentation
Female
Follow-Up Studies
Humans
Internationality
Logistic Models
Male
Middle Aged
Minimally Invasive Surgical Procedures
/ methods
Multivariate Analysis
Patient Selection
Pneumonectomy
/ methods
Predictive Value of Tests
Pulmonary Emphysema
/ diagnostic imaging
Radiography, Interventional
/ methods
Respiratory Function Tests
Risk Assessment
Severity of Illness Index
Tomography, X-Ray Computed
/ methods
Treatment Outcome
COPD
HRCT
bronchoscopy
emphysema
endobronchial coils
lung volume reduction
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
30
11
2018
revised:
16
01
2019
accepted:
01
02
2019
pubmed:
25
2
2019
medline:
20
2
2020
entrez:
25
2
2019
Statut:
ppublish
Résumé
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. 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. 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. 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 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. ClinicalTrials.gov; No.: NCT01608490; URL: www.clinicaltrials.gov.
Sections du résumé
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
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.
Identifiants
pubmed: 30797746
pii: S0012-3692(19)30188-6
doi: 10.1016/j.chest.2019.02.012
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT01608490']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
928-937Investigateurs
F J F Herth
(FJF)
D Gompelmann
(D)
M Schuhmann
(M)
R Eberhardt
(R)
D Harzheim
(D)
B Rump
(B)
D J Slebos
(DJ)
N Ten Hacken
(N)
K Klooster
(K)
J E Hartman
(JE)
S Augustijn
(S)
P L Shah
(PL)
C Caneja
(C)
W McNulty
(W)
J Garner
(J)
G Deslée
(G)
H Vallerand
(H)
S Dury
(S)
D Gras
(D)
M Verdier
(M)
C H Marquette
(CH)
C Sanfiorenzo
(C)
C Clary
(C)
C Leheron
(C)
J Pradelli
(J)
S Korzeniewski
(S)
P Wolter
(P)
T Arfi
(T)
F Macone
(F)
M Poudenx
(M)
S Leroy
(S)
A Guillemart
(A)
J Griffonet
(J)
C Strange
(C)
R Argula
(R)
G Silvestri
(G)
J T Huggins
(JT)
N Pastis
(N)
D Woodford
(D)
L Schwarz
(L)
D Walker
(D)
G Criner
(G)
J Mamary
(J)
N Marchetti
(N)
P Desai
(P)
K Shenoy
(K)
J L Garfield
(JL)
J Travaline
(J)
H Criner
(H)
S Srivastava-Malhotra
(S)
V Tauch
(V)
R Maxfield
(R)
K Brenner
(K)
W Bulman
(W)
B A Whippo
(BA)
P A Jellen
(PA)
R Kalhan
(R)
C T Gillespie
(CT)
S Rosenberg
(S)
M McAvoy DeCamp
(M)
A S Rogowski
(AS)
J Hixon
(J)
L F Angel
(LF)
O Dib
(O)
F C Sciurba
(FC)
D Chandra
(D)
M Crespo
(M)
J Bon Field
(JB)
J Rahul Tedrow
(JR)
C Ledezma
(C)
P Consolaro
(P)
M Beckner
(M)
A Majid
(A)
G Cheng
(G)
J Cardenas-Garcia
(J)
D Beach
(D)
E Folch
(E)
A Agnew
(A)
W Hori
(W)
A Nathanson
(A)
M Wahidi
(M)
S Shofer
(S)
M Hartwig
(M)
K Mahmood
(K)
E Smathers
(E)
W Tillis
(W)
K Verma
(K)
D Taneja
(D)
M Peil
(M)
S Chittivelu
(S)
P Doloszycki
(P)
P E Whitten
(PE)
B Aulakh
(B)
O Ikadios
(O)
J Michel
(J)
J Crabb
(J)
B McVay
(B)
A Scott
(A)
E A Pautler
(EA)
T A Connolly
(TA)
J F Santacruz
(JF)
L Kopas
(L)
R Parham
(R)
B Solid
(B)
W Krimsky
(W)
F Gregoire
(F)
S King
(S)
A Mehta
(A)
F Almeida
(F)
T Gildea
(T)
J Cicenia
(J)
M Machuzak
(M)
S Sethi
(S)
Y M Meli
(YM)
J Baran
(J)
R Rice
(R)
D Faile
(D)
N Rai
(N)
K Jensen
(K)
R Kahlstrom
(R)
A Haroon
(A)
R Ionita
(R)
F White
(F)
D Watkins
(D)
B Moore
(B)
H Soukiasian
(H)
H Merry
(H)
Z Mosenifar
(Z)
S Ghandehari
(S)
D Balfe
(D)
J Park
(J)
R Mardirosian
(R)
J S Ferguson
(JS)
J Kanne
(J)
D Sonetti
(D)
D Modi
(D)
M Regan
(M)
J Maloney
(J)
M Hackbarth
(M)
M Gilles
(M)
A Harris
(A)
A Maser
(A)
J T Puchalski
(JT)
C Rochester
(C)
J Possick
(J)
K Johnson
(K)
Z Dabre
(Z)
K Kovitz
(K)
M Joo
(M)
J DeLisa
(J)
S V Villalan
(SV)
G Krishna
(G)
J Canfield
(J)
A Marfatia
(A)
E Selley
(E)
S V Villalan
(SV)
J Utz
(J)
D Midthun
(D)
R Kern
(R)
E S Edell
(ES)
L L Boras Née Kosok
(LL)
S Gay
(S)
K A Bauman
(KA)
M King Han
(M)
R L Sagana
(RL)
K Nelson
(K)
C Meldrum
(C)
M Jantz
(M)
H J Mehta
(HJ)
C Eagan
(C)
J West
(J)
A Delage
(A)
S Martel
(S)
P LeBlanc
(P)
F Maltais
(F)
Y Lacasse
(Y)
N Lampron
(N)
F Laberge
(F)
J Milot
(J)
J Picard
(J)
M J Breton
(MJ)
M Dransfield
(M)
J M Wells
(JM)
S Bhatt
(S)
P Smith
(P)
E N Seabron-Harris
(EN)
K Hammond
(K)
C Egidio
(C)
Informations de copyright
Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.