Chest
Volume 124, Issue 5, November 2003, Pages 1863-1870
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Clinical Investigations
SURGERY
Effects of Lung Volume Reduction Surgery on Left Ventricular Diastolic Filling and Dimensions in Patients With Severe Emphysema*

https://doi.org/10.1378/chest.124.5.1863Get rights and content

Study objectives

Data on the influence of lung volume reduction surgery (LVRS) on cardiac function and hemodynamics are scarce and controversial. Previous studies have focused mainly on right ventricular function and pulmonary hemodynamics. Here, we evaluated the effects of LVRS on left ventricular (LV) end-diastolic filling pattern, dimensions, stiffness, and performance, as well as pulmonary and systemic hemodynamics.

Design

A prospective, open, controlled study.

Patients

Patients with severe emphysema undergoing LVRS (10 patients). Patients scheduled for pulmonary lobectomy due to carcinoma (ie, the lobectomy group) served as control subjects (10 patients).

Measurements

LV dimensions and mitral flow velocities were measured by transesophageal, two-dimensional, Doppler echocardiography, and central hemodynamics were measured by a pulmonary artery thermodilution catheter. Measurements were performed during anesthesia in the supine position, before and after surgery, without and with passive leg elevation.

Results

Baseline cardiac index (CI) [− 21%], stroke volume index (SVI) [− 31%], stroke work index (SWI) [− 26%], and LV end-diastolic area index (EDAI) [− 15%] were significantly (p < 0.001) lower, whereas LV end-diastolic stiffness (LVEDS) did not differ in the LVRS group compared to the lobectomy group. The time from peak early diastolic filling to zero flow (E-dec time) [58%] and the deceleration slope of early diastolic filling (E-dec slope) [45%] were significantly higher (p < 0.01), whereas peak early diastolic filling velocity (E-max) [− 31%; p < 0.01] and the proportion of E-max vs peak late diastolic filling velocity (A-max) [ie, the E/A ratio] (− 27%; p < 0.001) were significantly lower compared to the lobectomy group. LVRS significantly increased CI (40%; p < 0.001), SVI (34%; p < 0.001), SWI (58%; p < 0.001), LV EDAI (18%; p < 0.001), E-max (44%; p < 0.01), A-max (15%; p < 0.05) and E/A ratio (28%; p < 0.01), decreased E-dec time (− 31%; p < 0.05) and E-dec slope (− 98%; p < 0.01), and had no effect on LVEDS. In the lobectomy group, surgery affected none of these variables.

Conclusions

LV function is impaired in patients with severe emphysema due to small end-diastolic dimensions. LVRS increases LV end-diastolic dimensions and filling, and improves LV function.

Section snippets

Patients

The local Ethics Committee of the Medical Faculty of Go¨teborg University approved the study protocol. Twenty patients were included in the study. The LVRS group consisted of 10 consecutive patients who were scheduled for LVRS due to severe pulmonary emphysema (ie, the LVRS group), whereas 10 patients scheduled for lobectomy due to pulmonary carcinoma served as control subjects (ie, the control group).

The criteria for inclusion in the LVRS group were as follows: a diagnosis of emphysema based

Patients

The patients in the LVRS group consisted of five men and five women, whereas six women and four men were included in the control group. There were no differences between the groups regarding age, height, or weight (Table 1). As shown in Table 2, the patients undergoing LVRS had the typical functional features of severe pulmonary emphysema, consisting of severe obstruction to expiratory airflow and considerable hyperinflation. The mean SPAP was 34 ± 3 mm Hg, and the mean LV AEF was 62 ± 2%, as

Discussion

We investigated LV performance in a group of patients with severe pulmonary emphysema who were undergoing LVRS. To compare these patients to nonemphysematous patients with regard to central hemodynamics and LV function, and to exclude the surgical procedure per se as the source of potential effects, we included a control group of patients undergoing lobectomy for pulmonary carcinoma (ie, the lobectomy group). Preoperative LV performance was depressed in patients with severe pulmonary emphysema

Conclusion

In the present study, we evaluated the immediate effects of LVRS for severe emphysema on LV end-diastolic filling, dimensions, and stiffness as well as pulmonary and systemic hemodynamics in comparison with pulmonary lobectomy for lung cancer. Before surgery, the LVRS group had a lower LV performance, as demonstrated by lower values for SVI, SWI, and CI when compared with the lobectomy group. This was due to a lower baseline LV preload, as indicated by the presence of a lower LV EDAI and mitral

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  • Cited by (0)

    This study was supported by grant No. 13156 from the Swedish Medical Research Council and by the Medical Faculty of Gothenburg (LUA).

    This study was partly presented at the ninth Annual Meeting of the European Society of Anaesthesiologists, Gothenburg, Sweden, April 7–10, 2001, and at the Annual Meeting of the International Society of Heart and Lung Transplantation, Washington, DC, April 10–13, 2002.

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