D92-06 Airway Scaffolds Improve Ventilation Heterogeneity in Patients With Emphysema-related Hyperinflation

Abstract Rationale Ventilation heterogeneity (VH) refers to uneven regional ventilation, leading to ventilation–perfusion (V/Q) mismatch, inefficient gas exchange, and impaired respiratory mechanics. In emphysema, VH may contribute to dyspnoea and exercise limitation. CT:VQ by 4DMedical is an FDA-approved imaging technology that converts standard non-contrast chest CT scans into quantitative ventilation (V) and perfusion (Q) maps, enabling objective assessment of VH. The Apreo BREATHE Airway Scaffold is a self-expanding nitinol implant deployed bronchoscopically to release trapped air from hyperinflated emphysematous regions and improve lung mechanics. While prior studies have demonstrated significant improvements in symptoms, exercise capacity, and lung function, the impact of this device on VH has not been established. The aim was to evaluate changes in VH following Apreo BREATHE Scaffold treatment using CT:VQ imaging. Methods Twenty-one subjects with emphysema-related hyperinflation were treated bilaterally with three scaffolds per lung at the Royal Brompton Hospital as part of the first-in-human BREATHE-2 study. Inspiratory and expiratory non-contrast CT scans were acquired at baseline and six months post-treatment. VH was quantified using CT:VQ technology. A subgroup analysis included patients with a baseline VH score ≥ 50. Changes in end-inspiratory volume (EIV), end-expiratory volume (EEV), and VH were compared using paired statistical analysis. Results Eighteen subjects had paired scans meeting CT:VQ quality criteria. The mean age was 62.9 years, mean smoking exposure was 40.5 pack-years, and 21% were male. Following treatment, EIV and EEV decreased by 184 mL (p = 0.0008) and 593 mL (p = 0.004), respectively. Mean VH decreased by 9.8% (p = 0.19) overall. Among patients with a baseline VH score ≥ 50 (n = 12), VH decreased by 20.3% (p = 0.012), indicating significantly improved ventilation distribution in those with the highest initial heterogeneity. Conclusion Apreo BREATHE Scaffold treatment was associated with reductions in lung volumes and improved ventilation distribution, as demonstrated by CT:VQ imaging. The greatest VH improvement occurred in patients with high baseline heterogeneity, suggesting that VH may serve as a physiological biomarker for treatment response. Larger controlled studies are warranted to confirm these findings and further define the clinical utility of VH in assessing emphysema therapies and V/Q mismatch correction. This abstract is funded by: Data derived from the study was funded by Apreo Health