Impact of Endoscopic Lung Volume Reduction on Right Ventricular Myocardial Function

INTRODUCTION: Endoscopic lung volume reduction (ELVR) provides a minimally invasive therapy for patients with severe lung emphysema. As its impact on right ventricular (R(t)V) function is undefined, we examined the extent of R(t)V functional changes following ELVR, as assessed by use of speckle tracking-based R(t)V deformation analysis. METHODS: We enrolled 32 patients with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr, PulmonX, Inc.), comprising 16 matched clinical responders and 16 non-responders. Echocardiography was conducted one day prior to ELVR and at an eight-week postprocedural interval. RESULTS: Patients were predominantly of late middle-age (65.8±8.7yrs), male (62.5%) and presented advanced COPD emphysema (means FEV1 and RV: 32.6% and 239.1% of predicted, respectively). After ELVR, R(t)V apical longitudinal strain improved significantly in the total study cohort (-7.96±7.02% vs. -13.35±11.48%, p=0.04), whereas there were no significant changes in other parameters of R(t)V function such as R(t)V global longitudinal strain, TAPSE or pulmonary arterial systolic pressure. In responding patients, 6MWT-improvement correlated with a decrease in NT-proBNP (Pearson´s r: -0.53, p=0.03). However, clinical non-responders did not exhibit any R(t)V functional improvement. DISCUSSION: ELVR beneficially impacts R(t)V functional parameters. Speckle tracking-based R(t)V apical longitudinal strain analysis allows early determination of R(t)V contractile gain and identification of clinical responsiveness.