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Apical Perfusion Fraction as a Predictor of Short-term Functional Outcome Following Bilateral Lung Volume Reduction Surgery^*

^* From the Pulmonary, Allergy, and Critical Care Division (Drs. Kotloff, Hansen-Flaschen, Lipson, Tino, and Arcasoy), Division of Nuclear Medicine (Dr. Alavi), and Division of Cardiothoracic Surgery (Dr. Kaiser), University of Pennsylvania Medical Center, Philadelphia, PA.

Correspondence to: Robert M. Kotloff, MD, FCCP, Pulmonary, Allergy, and Critical Care Division, 838 West Gates, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104; e-mail: kotloff{at}mail.med.upenn.edu

Study objectives: To examine whether relative hypoperfusion to the apical one third of the lungs as determined by lung scintigraphy predicts a favorable functional outcome following bilateral lung volume reduction surgery (LVRS).

Methods: We performed a retrospective analysis of 128 patients who underwent bilateral LVRS. An apical perfusion fraction (AP%), defined as the percentage of total lung perfusion to the apical one third of both lungs, was derived for each patient by quantitative scintigraphy technique. Pulmonary function testing and 6-min walk test (6MWT) data were obtained preoperatively and 3 to 6 months postoperatively.

Results: The mean (± SD) improvement in FEV₁ was 309 ± 240 mL, 209 ± 293 mL, and 116 ± 224 mL for patients with an AP% of 10%, 11 to 20%, and > 20%, respectively (p = 0.01, analysis of variance [ANOVA]). The likelihood of experiencing an increase in FEV₁ 200 mL was 68% for those with an AP% 10% but only 31% for those with an AP% > 20%. Preoperative and postoperative 6MWT data were available for 109 of 128 patients. Improvement was 250 ± 252 feet, 205 ± 299 feet, and 77 ± 200 feet for patients with AP% 10%, 11 to 20%, and > 20%, respectively (p = 0.04, ANOVA). While 50% of those with an AP% 10% improved their 6MWT by 180 feet, only 21% of those with an AP% > 20% did so.

Conclusion: This retrospective analysis suggests that quantification of apical perfusion by nuclear scintigraphy assists in predicting the likelihood of short-term functional improvement after LVRS.

Key Words: COPD • emphysema • lung volume reduction surgery • perfusion scintigraphy

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