Radiological and clinical outcomes of using Chartis™ to plan endobronchial valve treatment

One-way endobronchial valves (EBVs) have been shown to relieve symptoms of emphysema, particularly in patients without collateral ventilation (CV) between the target and adjacent lobes. In this study, we investigated the ability of the bronchoscopic Chartis™ Pulmonary Assessment System to predict treatment response by determining the presence of CV. 80 EBV patients underwent a pre-treatment Chartis assessment. Before and 30 days after implantation, high-resolution computed tomography scans were taken to determine target lobe volume reduction (TLVR). A pre- to post-treatment reduction of ≥350 mL was defined as significant. In addition, clinical outcomes (forced expiratory volume in 1 s (FEV1), 6-min walk test and St George’s Respiratory Questionnaire) were compared over the same time period. Of the 51 patients classified as having an absence of CV according to their Chartis reading, 36 showed a TLVR ≥350 mL. 29 patients were classified as having CV, and of these 24 did not meet this TLVR cut-off. Chartis showed an accuracy level of 75% in predicting whether or not the TLVR cut-off would be reached. Those predicted to respond showed significantly greater TLVR (p<0.0001) and FEV1 improvement (p=0.0013) than those predicted not to respond. Chartis is a safe and effective method of predicting response to EBV treatment.

[1]  D. Flenley,et al.  Portable oxygen and exercise tolerance in patients with chronic hypoxic cor pulmonale. , 1977, British medical journal.

[2]  B. Raasch,et al.  Radiographic anatomy of the interlobar fissures: a study of 100 specimens. , 1982, AJR. American journal of roentgenology.

[3]  Phillips Yy,et al.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986. , 1987, The American review of respiratory disease.

[4]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. , 2001, American journal of respiratory and critical care medicine.

[5]  Steven Piantadosi,et al.  A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. , 2003, The New England journal of medicine.

[6]  D. Mannino,et al.  Global burden of COPD: systematic review and meta-analysis , 2006, European Respiratory Journal.

[7]  Geoffrey McLennan,et al.  Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT): a non-surgical method of lung volume reduction , 2007, BMC pulmonary medicine.

[8]  B. Make,et al.  Pulmonary rehabilitation in emphysema. , 2008, Proceedings of the American Thoracic Society.

[9]  M Cazzola,et al.  Outcomes for COPD pharmacological trials: From lung function to biomarkers. , 2008, Revista portuguesa de pneumologia.

[10]  G. Criner,et al.  National Emphysema Treatment Trial: the major outcomes of lung volume reduction surgery in severe emphysema. , 2008, Proceedings of the American Thoracic Society.

[11]  B. Make,et al.  The minimal important difference of exercise tests in severe COPD , 2010, European Respiratory Journal.

[12]  G. Michaud,et al.  Predicting Atelectasis by Assessment of Collateral Ventilation prior to Endobronchial Lung Volume Reduction: A Feasibility Study , 2010, Respiration.

[13]  D. Hansell,et al.  Atelectasis and survival after bronchoscopic lung volume reduction for COPD , 2010, European Respiratory Journal.

[14]  G. McLennan,et al.  A randomized study of endobronchial valves for advanced emphysema. , 2010, The New England journal of medicine.

[15]  F. Venuta,et al.  Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema , 2011, European Respiratory Journal.

[16]  M. Noppen,et al.  Efficacy predictors of lung volume reduction with Zephyr valves in a European cohort , 2012, European Respiratory Journal.

[17]  F. Martinez,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. , 2007, American journal of respiratory and critical care medicine.