Invasive RV pressure-volume loops show hemodynamic benefits of reducing lung hyperinflation in COPD - 29/10/26
Highlights |
• | This is the first study to extensively assess right heart hemodynamics in COPD patients using pressure – volume catheters, before and after endoscopic lung volume reduction (ELVR) conducted using endobronchial valves. |
• | We found that a reduction in hyperinflation results in improvements in right heart relaxation time Tau and End Diastolic Pressure – Volume Relationships. |
• | These resullts confirm the interaction between lung hyperinflation and cardiac hemodynamics and suggest that right heart failure is at least partially reversible in COPD patients. |
Graphical abstract |
Abstract |
Aims |
Right heart dysfunction is a common complication in chronic obstructive pulmonary disease (COPD), yet the underlying mechanisms remain poorly understood. Endoscopic lung volume reduction (ELVR) using Zephyr® valves improves lung function by reducing emphysema-induced hyperinflation, providing clinical benefits beyond enhanced pulmonary mechanics. Magnetic resonance imaging studies suggest that alleviating lung hyperinflation may also positively affect left heart function. We hypothesized that ELVR may also improve right heart function.
Research question |
This study evaluated right heart function after ELVR in patients with COPD using invasive pressure-volume loop analysis.
Study design and methods |
Eleven patients with severe COPD underwent baseline right heart catheterization because of suspected pulmonary hypertension, and pressure-volume loop analysis. Eight patients underwent ELVR, followed by right heart function reassessment 12 weeks post-procedure.
Results |
Pre-ELVR, pulmonary artery pressures ranged from 23 to 32 mmHg, vascular resistance was 2.2-4.8 WU, and significant impaired pressure-volume indexes were observed compared to reference data. Post-ELVR, lung hyperinflation improved significantly, with a reduction in the Residual Volume /Total Lung Capacity (RV/TLC) ratio. RV/TLC changes correlated with improvements in end-diastolic pressure-volume relationships (r=0.82, P =0.02) and the time constant of relaxation Tau (r=0.84, P =0.01). Functional outcomes, such as 6-minute walk distance and dyspnea scores, were driven by stroke work and diastolic parameters, respectively.
Conclusions |
In this exploratory single center study, endoscopic lung volume reduction with associated improvement in hyperinflation led to significant improvement in exercise capacity and in right ventricular function.
Le texte complet de cet article est disponible en PDF.Keywords : Emphysema, pulmonary hypertension (PH), Endoscopic lung volume reduction (ELVR), Heart failure with preserved ejection fraction (HFpEF)
Plan
Vol 90
Article 101330- novembre 2026 Retour au numéro
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