ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Effects of Bronchoscopic Lung Volume Reduction with Endobronchial Valves (EBV) on Diaphragm Thickness Fraction
Session Title
TP40 - TP040 COPD CLINICAL TRIALS AND THERAPIES
Abstract
A2262 - Effects of Bronchoscopic Lung Volume Reduction with Endobronchial Valves (EBV) on Diaphragm Thickness Fraction
Author Block: M. Patel1, M. Zheng1, O. A. O'Corragain1, M. Gordon1, P. B. Desai1, Z. L. Dorey-Stein2, J. Thomas1, L. H. Criner1, N. Patlakh1, N. Marchetti1, G. J. Criner1; 1Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, United States, 2Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, United States.
Purpose: Bronchoscopic lung volume reduction (BLVR) with endobronchial valves is an FDA treatment of severe hyperinflation in advanced emphysema. Hyperinflation decreases diaphragm precontraction length and impairs inspiration force generation which leads to increased central motoneuron output and increased dyspnea via electromechanical uncoupling. We hypothesize that BLVR improves diaphragm function as evidenced by increased diaphragm thickening shown by ultrasound imaging. Methods: We performed a prospective study of patients with BLVR from Aug 2020-Dec 2020. Thickness fractions (TF) of the Diaphragm were measured pre-procedure, at day 5 and at 45 days post-procedure. Diaphragm TF was measured with patient in 45 degrees semi-recumbent position. Using the B-mode imaging with a high frequency probe, the diaphragm was visualized at zone of apposition. Diaphragm thickness measured at Tidal inspiration (TDin), after tidal expiration (TDFRC), after maximal inspiration (TDTLCi) and after maximal expiration (TDTLCex). Thickening fraction was calculated during tidal breathing (TDTF) as (TDin-TDFRC)/TDFRC and at TLC(TLCTF) as (TDTLCi-TDTLCex)/TDTLCex. TF measurements were performed on both the treatment and non-treatment side. Pulmonary function tests (PFT) before and after the BLVR were also collected. Furthermore, only patients who had a reduction in residual volume (RV) by 250 cc in response to BLVR were included in the final analysis. Pearson Correlation coefficient were used for determining relationships between the variables. Results: We included 15 patients, of which 9 met inclusion criteria. 7 patients had measurements at both day 5, while only 4 had a 45-day follow-up. The baseline demographics of our population were average age 53.6+6.8 years, 5 were females. Baseline pulmonary function tests showed average FEV1 0.78 +0.31 L (29% pred. + 7.3), FVC 2.38+1.09 L(66%+19pred.), residual volume (RV) 4.36 + 1.14 L(206 % + 71 Pred.) and total lung capacity (TLC) 7.06+1.44 L(123%+22 pred). Change in RV inversely correlated with improvement in TDTF and TLCTF at 45 days on both treatment (R2 = 0.86 p = 0.07 (TDTF), R2=0.863 p= 0.07 (TLCTF)) and nontreatment sides (R2 = 0.05 p=0.7 (TDTF), R2 = 0.40 p =0.3 (TLCTF)). Improvement in FVC also positively corelated with treatment side TDTF (R2 = 0.35, p = 0.4) and TLCTF (R2 = 0.60, p=0.22) (figure 1). Our preliminary analysis was not powered for statistical significance. Conclusion: BLVR can improve diaphragm TF and may thus improve diaphragm mechanical action. The improvement in TF may improve diaphragm force generation and help restore the normal balance of electromechanical coupling thereby reducing dyspnea.
Author Block: M. Patel1, M. Zheng1, O. A. O'Corragain1, M. Gordon1, P. B. Desai1, Z. L. Dorey-Stein2, J. Thomas1, L. H. Criner1, N. Patlakh1, N. Marchetti1, G. J. Criner1; 1Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, United States, 2Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, United States.
Purpose: Bronchoscopic lung volume reduction (BLVR) with endobronchial valves is an FDA treatment of severe hyperinflation in advanced emphysema. Hyperinflation decreases diaphragm precontraction length and impairs inspiration force generation which leads to increased central motoneuron output and increased dyspnea via electromechanical uncoupling. We hypothesize that BLVR improves diaphragm function as evidenced by increased diaphragm thickening shown by ultrasound imaging. Methods: We performed a prospective study of patients with BLVR from Aug 2020-Dec 2020. Thickness fractions (TF) of the Diaphragm were measured pre-procedure, at day 5 and at 45 days post-procedure. Diaphragm TF was measured with patient in 45 degrees semi-recumbent position. Using the B-mode imaging with a high frequency probe, the diaphragm was visualized at zone of apposition. Diaphragm thickness measured at Tidal inspiration (TDin), after tidal expiration (TDFRC), after maximal inspiration (TDTLCi) and after maximal expiration (TDTLCex). Thickening fraction was calculated during tidal breathing (TDTF) as (TDin-TDFRC)/TDFRC and at TLC(TLCTF) as (TDTLCi-TDTLCex)/TDTLCex. TF measurements were performed on both the treatment and non-treatment side. Pulmonary function tests (PFT) before and after the BLVR were also collected. Furthermore, only patients who had a reduction in residual volume (RV) by 250 cc in response to BLVR were included in the final analysis. Pearson Correlation coefficient were used for determining relationships between the variables. Results: We included 15 patients, of which 9 met inclusion criteria. 7 patients had measurements at both day 5, while only 4 had a 45-day follow-up. The baseline demographics of our population were average age 53.6+6.8 years, 5 were females. Baseline pulmonary function tests showed average FEV1 0.78 +0.31 L (29% pred. + 7.3), FVC 2.38+1.09 L(66%+19pred.), residual volume (RV) 4.36 + 1.14 L(206 % + 71 Pred.) and total lung capacity (TLC) 7.06+1.44 L(123%+22 pred). Change in RV inversely correlated with improvement in TDTF and TLCTF at 45 days on both treatment (R2 = 0.86 p = 0.07 (TDTF), R2=0.863 p= 0.07 (TLCTF)) and nontreatment sides (R2 = 0.05 p=0.7 (TDTF), R2 = 0.40 p =0.3 (TLCTF)). Improvement in FVC also positively corelated with treatment side TDTF (R2 = 0.35, p = 0.4) and TLCTF (R2 = 0.60, p=0.22) (figure 1). Our preliminary analysis was not powered for statistical significance. Conclusion: BLVR can improve diaphragm TF and may thus improve diaphragm mechanical action. The improvement in TF may improve diaphragm force generation and help restore the normal balance of electromechanical coupling thereby reducing dyspnea.
