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Chest. 2019 Feb 21. pii: S0012-3692(19)30188-6. doi: 10.1016/j.chest.2019.02.012. [Epub ahead of print]

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

Collaborators (188)

Herth FJF, Gompelmann D, Schuhmann M, Eberhardt R, Harzheim D, Rump B, Slebos DJ, Ten Hacken N, Klooster K, Hartman JE, Augustijn S, Shah PL, Caneja C, McNulty W, Garner J, Deslée G, Vallerand H, Dury S, Gras D, Verdier M, Marquette CH, Sanfiorenzo C, Clary C, Leheron C, Pradelli J, Korzeniewski S, Wolter P, Arfi T, Macone F, Poudenx M, Leroy S, Guillemart A, Griffonet J, Strange C, Argula R, Silvestri G, Huggins JT, Pastis N, Woodford D, Schwarz L, Walker D, Criner G, Mamary J, Marchetti N, Desai P, Shenoy K, Garfield JL, Travaline J, Criner H, Srivastava-Malhotra S, Tauch V, Maxfield R, Brenner K, Bulman W, Whippo BA, Jellen PA, Kalhan R, Gillespie CT, Rosenberg S, McAvoy DeCamp M, Rogowski AS, Hixon J, Angel LF, Dib O, Sciurba FC, Chandra D, Crespo M, Field JB, Tedrow JR, Ledezma C, Consolaro P, Beckner M, Majid A, Cheng G, Cardenas-Garcia J, Beach D, Folch E, Agnew A, Hori W, Nathanson A, Wahidi M, Shofer S, Hartwig M, Mahmood K, Smathers E, Tillis W, Verma K, Taneja D, Peil M, Chittivelu S, Doloszycki P, Whitten PE, Aulakh B, Ikadios O, Michel J, Crabb J, McVay B, Scott A, Pautler EA, Connolly TA, Santacruz JF, Kopas L, Parham R, Solid B, Krimsky W, Gregoire F, King S, Mehta A, Almeida F, Gildea T, Cicenia J, Machuzak M, Sethi S, Meli YM, Baran J, Rice R, Faile D, Rai N, Jensen K, Kahlstrom R, Haroon A, Ionita R, White F, Watkins D, Moore B, Soukiasian H, Merry H, Mosenifar Z, Ghandehari S, Balfe D, Park J, Mardirosian R, Ferguson JS, Kanne J, Sonetti D, Modi D, Regan M, Maloney J, Hackbarth M, Gilles M, Harris A, Maser A, Puchalski JT, Rochester C, Possick J, Johnson K, Dabre Z, Kovitz K, Joo M, DeLisa J, Villalan SV, Krishna G, Canfield J, Marfatia A, Selley E, Villalan SV, Utz J, Midthun D, Kern R, Edell ES, Boras Née Kosok LL, Gay S, Bauman KA, King Han M, Sagana RL, Nelson K, Meldrum C, Jantz M, Mehta HJ, Eagan C, West J, Delage A, Martel S, LeBlanc P, Maltais F, Lacasse Y, Lampron N, Laberge F, Milot J, Picard J, Breton MJ, Dransfield M, Wells JM, Bhatt S, Smith P, Seabron-Harris EN, Hammond K, Egidio C.

Author information

1
Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: d.j.slebos@umcg.nl.
2
Cleveland Clinic Foundation, Cleveland, OH.
3
University of Pittsburgh School of Medicine, Pittsburgh, PA.
4
Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
5
Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
6
Royal Brompton Hospital and Chelsea and Westminster Hospital, London, UK.
7
University Hospital of Reims, INSERM U1250, Reims, France.
8
Quebec Heart and Lung Institute, Quebec City, QC, Canada.
9
University of Florida, Gainesville, FL.
10
University Nice Sophia Antipolis, IRCAN, ONCOAGE, Nice, France.
11
Medical University of South Carolina, Charleston, SC.
12
PneumRx, Inc., a BTG International group company, Santa Clara, CA.
13
PneumRx GmbH, a BTG International group company, Düsseldorf, Germany; Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
14
Thoraxklinik and Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany.
15
Royal Brompton Hospital and Chelsea and Westminster Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.

Abstract

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 FEV1 (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.

KEYWORDS:

COPD; HRCT; bronchoscopy; emphysema; endobronchial coils; lung volume reduction

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