Objectives: Fissure integrity and lobar occlusion are known predictors for a beneficial outcome following endoscopic valve therapy in emphysema patients. Parameters assessed by multi-detector computed tomography (MDCT) particularly lobar deflation were also hypothesized to have impact on the clinical outcome after valve therapy but have not been sufficiently investigated for their predictive character.

Methods: Clinical and MDCT parameters of emphysema patients were retrospectively analyzed for their predictive impact on the clinical outcome following valve placement. Changes in forced expiratory volume in 1 second (FEV1), residual volume (RV) and 6-minute walk test (6-MWT) from baseline to 3 months following valve therapy were assessed to evaluate the clinical outcome. The impact of various clinical variables and MDCT parameters on the clinical outcome were analyzed.

Results: 167 COPD patients (51% male, mean age 65±7 years, mean FEV1 32%±9%, mean RV 264%±57%) experienced a mean FEV1 increase of 0.1±0.25L, a mean RV decrease of 0.83 ± 1.06L and a mean improvement of 18±74m in the 6-MWT at 3-month follow-up after valve therapy. Deflation of the target lobe and deflation of the target lung/deflation of the total lung (for FEV1), baseline lung function parameters (for FEV1 and RV), age (for FEV1 and 6-MWT), weight or BMI (for FEV1 and RV), 6-MWT (for 6-MWT) and volume of the total lung (for FEV1 and RV), were identified as significant predictors for clinical improvement (all p<0.05).

Conlusion: These findings suggest that lobar deflation has impact on the clinical outcome following endoscopic valve therapy and thus should be taken into account for planning the valve procedure.