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

RENEW Study Group

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)928-937
Number of pages10
JournalCHEST
Volume155
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Emphysema
Residual Volume
Therapeutics
Pneumonectomy
Radiology
Patient Selection
Registries
Thorax
Logistic Models
Regression Analysis
Quality of Life
Exercise
Lung

Keywords

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

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

RENEW Study Group. / Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema. In: CHEST. 2019 ; Vol. 155, No. 5. pp. 928-937.
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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.",
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Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema. / RENEW Study Group.

In: CHEST, Vol. 155, No. 5, 01.05.2019, p. 928-937.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema

AU - RENEW Study Group

AU - Slebos, Dirk Jan

AU - Cicenia, Joseph

AU - Sciurba, Frank C.

AU - Criner, Gerard J.

AU - Hartman, Jorine E.

AU - Garner, Justin

AU - Deslée, Gaëtan

AU - Delage, Antoine

AU - Jantz, Michael

AU - Marquette, Charles Hugo

AU - Strange, Charlie

AU - Hatipoglu, Umur

AU - Mehta, Atul C.

AU - LaPrad, Adam S.

AU - Schmid-Bindert, Gerald

AU - Herth, Felix J.F.

AU - Shah, Pallav L.

AU - Herth, F. J.F.

AU - Gompelmann, D.

AU - Schuhmann, M.

AU - Eberhardt, R.

AU - Harzheim, D.

AU - Rump, B.

AU - Slebos, D. J.

AU - Ten Hacken, N.

AU - Klooster, K.

AU - Hartman, J. E.

AU - Augustijn, S.

AU - Shah, P. L.

AU - Caneja, C.

AU - McNulty, W.

AU - Garner, J.

AU - Deslée, G.

AU - Vallerand, H.

AU - Dury, S.

AU - Gras, D.

AU - Verdier, M.

AU - Marquette, C. H.

AU - Sanfiorenzo, C.

AU - Clary, C.

AU - Leheron, C.

AU - Pradelli, J.

AU - Korzeniewski, S.

AU - Wolter, P.

AU - Arfi, T.

AU - Macone, F.

AU - Poudenx, M.

AU - Kalhan, Ravi

AU - Gillespie, Colin Thomas

AU - Rosenberg, Sharon Reifler

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

KW - COPD

KW - HRCT

KW - bronchoscopy

KW - emphysema

KW - endobronchial coils

KW - lung volume reduction

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JO - Chest

JF - Chest

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