Echocardiogram parameters in patients with COPD in the year after endoscopic lung volume reduction (ELVR)

Abstract

Introduction: ELVR with valves improves lung function, exercise tolerance and quality of life (QOL) in selected patients with severe COPD. We assessed transthoracicechocardiogram (TTE) parameters in COPD patients before and after ELVR. Our previous work in patients with large intra-thoracic hiatus hernias showed significant improvements in dyspnoea after surgery were due to reduction in left atrial compression (LAC). We theorized that improvements in QOL post ELVR may be also due to reduced LAC (when LUL was targeted) and reduction in pulmonary hypertension (PHT). Aims: To determine the effect of ELVR on TTE parameters, specifically right ventricular systolic pressure (RVSP) and LA size. Methods: 45 patients who underwent ELVR from 2012 to 2014 had TTE before, and 1, 3 and 12 months after ELVR. LA diameter, LA size, and RVSP were determined. We also performed subset analysis of LA diameter and size in 21 patients who had LUL procedure. Results: Mean (SEM) RVSP increased from 36.3(2.1) mmHg baseline to 38.6(2.1) 1m, 37.2(2.7) 3m, and 40.6(3.2) 12m (p Conclusion: In our patient cohort, PHT continued to progress despite ELVR and improvements in QOL, lung function and exercise tolerance. The LA size and diameter in 12 months in the LUL targeted group did not show any significant change. A larger cohort is required to determine if ELVR of the LUL reduces LAC and contributes to short-term improvement in symptoms.