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This Article Full Text (PDF) Free All Versions of this Article: chest.07-0041v1 132/5/1476    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Falk, J. A. Articles by Criner, G. J. Search for Related Content PubMed PubMed Citation Articles by Falk, J. A. Articles by Criner, G. J.

Lung Elastic Recoil Does Not Correlate with Pulmonary Hemodynamics in Severe Emphysema

From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, David Geffen School of Medicine at UCLA; the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania; and the University of Maryland School of Medicine, Baltimore, Maryland for the National Emphysema Treatment Trial (NETT) Research Group

falkja{at}cshs.org

Abstract

BackgroundIt has been postulated that right ventricular function may improve after lung volume reduction surgery (LVRS) for severe emphysema due to improvement in lung elastic recoil. Improved lung elastic recoil, post LVRS, is hypothesized to "tether" open extra-alveolar vessels, thereby leading to a decrease in pulmonary vascular resistance and improved right ventricular function. Whether a relationship exists between static elastic lung recoil and pulmonary hemodynamics in severe emphysema, however, is unknown. Methods: We prospectively studied 67 severe emphysema patients (32 female, 65.3±6.6 years, FEV₁ 0.79±0.25L), who were hyperinflated (TLC 122.5±12.3% predicted) and gas trapped (RV 209.1±41.1% predicted) referred to the National Emphysema Treatment Trial. Lung elastic recoil was measured both at total lung capacity (coefficient of retraction, CR) and at functional reserve capacity (CR_FRC) in each patient. Results: CR and CR_FRC (mean±SD) values were 1.3±0.6 and 0.61±0.5 cmH₂O/L, respectively. Hemodynamic measurements revealed a PA systolic pressure of 35.9±8.9 mmHg, mean PA pressure of 24.8±5.6 mmHg, and a PVR of 174±102 dyn*sec*cm^-5. No significant correlations were found between CR and PVR (R=-0.046, p=0.71), PA systolic pressure (R=0.005, p=0.97), or mean PA pressure (R=0.028, p=0.82). Additionally, no significant correlations were found between CR_FRC and PVR (R=-0.002, p=0.99), PA systolic pressure (R=-0.062, p=0.62), or mean PA pressure (R=-0.041, p=0.74). Conclusions: We conclude there is no correlation between lung elastic recoil and pulmonary hemodynamics in severe emphysema, suggesting that elastic lung recoil is not an important determinant of secondary pulmonary hypertension in this group. (registered with www.clinicaltrials.gov, #NCT00000606)

Key Words: Chronic Obstructive Pulmonary Disease • Compliance • Pulmonary Circulation • Pulmonary Hypertension