C23-03 Heterogeneity Matters Only in Lower Lobe Endoscopic Lung Volume Reduction With Valves

Abstract Rationale Endoscopic lung volume reduction (ELVR) with one-way valves is an established treatment for patients with severe lung emphysema. It has been shown to improve lung function, quality of life and exercise capacity. However, in many studies regarding ELVR patients with homogeneous lung emphysema are excluded or underrepresented. Studies such as IMPACT have shown less pronounced but still significant improvements in patients with homogeneous emphysema without further subgroup analyses. We therefore used real world data to investigate whether heterogeneity impacts the efficacy and safety of ELVR using real-world data and stratified patients into those with an upper lobe (UL) and those with a lower lobe (LL) treatment target. Methods All data orginates from the Lungenemphysemregister e.V., a multicenter, national and manufacturer-independent prospective study focusing on the treatment of severe emphysema with lung volume reduction. A patient was classified as having homogeneous emphysema if the difference in emphysema score (-950 HU) between target lobe and ipsilateral adjacent lobe was less than 15%. In this analysis, the following parameters were assessed at baseline and at follow-up: targeted lobe, lung function (FEV1, RV, pCO2), exercise capacity (6MWD), quality of life (SGRQ, mMRC, CAT) and adverse events. Results This analysis included 258 patients with homogeneous and 145 patients with heterogeneous emphysema. In 250 patients, the valves were placed in the LL, while 153 patients the UL was targeted in. At baseline, we observed no significant differences between all groups. When comparing the changes from baseline to three-month follow-up in all patients, we saw significant improvements in all measured parameters in both homogenous and heterogenous emphysema. The subgroup analyses revealed that only after valve implantation in the LL of either side there was a statistically significant difference in ΔFEV1, Δ6MWD, ΔCAT, and ΔSGRQ when comparing homogeneous and heterogenous lung emphysema, but interestingly not after valve treatment in the UL (Table 1). Adverse events were similar in all groups. Conclusions In this real-world cohort, patients with heterogeneous emphysema and LL valve placement showed the greatest functional and symptomatic improvements. These findings support the concept that careful patient and target lobe selection influence treatment outcomes and should be considered when planning ELVR. This abstract is funded by: None