Published ahead of print on May 11, 2007, doi:10.1164/rccm.200608-1114OC Am. J. Respir. Crit. Care Med., Volume 176, Number 3, August 2007, 253-260 A more recent version of this article appeared on August 1, 2007
Submitted on August 8, 2006 Effect of Lung Volume Reduction Surgery on Resting Pulmonary Hemodynamics in Severe EmphysemaGerard J Criner1*,1 Temple University, Philadelphia, PA, United States, 2 University of Maryland, Baltimore, MD, USA, 3 Johns Hopkins University, Baltimore, MD, USA, 4 Cleveland Clinic Foundation, Cleveland, OH, USA, 5 University of Pennsylvania, Philadelphia, PA, USA * To whom correspondence should be addressed. E-mail: crinerg{at}tuhs.temple.edu.
PURPOSE: To determine the effect of medical treatment vs lung volume reduction surgery (LVRS) on pulmonary hemodynamics METHODS: 3 clinical centers of the National Emphysema Treatment Trial (NETT) screened patients for additional inclusion into a cardiovascular (CV) substudy. Demographic, lung function testing, 6 minute walk distance (6 MWD) and maximum cardiopulmonary exercise testing were done at baseline and 6 months following medical therapy or LVRS. CV substudy patients underwent right heart catheterization (RHC) at rest pre-randomization (baseline) and 6 months following treatment. RESULTS: 110 of the 163 patients evaluated for the CV substudy were randomized in NETT (53 were ineligible), 54 to medical treatment and 56 to LVRS. 55 of 110 patients had both baseline and repeat RHC 6 months post randomization. Baseline demographics and lung function data revealed CV substudy patients to be similar to the remaining 1,163 randomized NETT patients in terms of age, gender, FEV1, residual volume, diffusion capacity, PaO2, PaCO2, and 6 MWD. CV substudy patients had moderate pulmonary hypertension at rest (24.8 ± 4.9mmHg), baseline hemodynamic measurements were similar across groups. Changes from baseline pressures to 6 months post treatment were similar across treatment groups, except for a smaller change in pulmonary capillary wedge pressure at end-expiration (PCWP EXP) post LVRS compared to Medical treatment (-1.8 vs 3.5 mm Hg, p=0.04). CONCLUSIONS: In comparison to medical therapy, LVRS was not associated with an increase in pulmonary artery pressures. Key words: emphysema, LVRS, lung volume reduction, COPD, pulmonary hemodynamics
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