Supplementary Material for: Outcomes of Endobronchial Valve Treatment Based on the Precise Criteria of an Endobronchial Catheter for Detection of Collateral Ventilation under Spontaneous Breathing

<b><i>Background:</i></b> Endoscopic lung volume reduction with valves is a valid therapeutic option for COPD patients with severe emphysema. The exclusion of interlobar collateral ventilation (CV) is an important predictor of clinical success. <b><i>Objectives:</i></b> Recently, a catheter-based endobronchial in vivo measurement system (Chartis, Pulmonx, USA) has become routine in the clinical evaluation of CV status in target lobes, but the criteria for phenotyping CV by Chartis evaluation have not yet been defined. We asked the questions, how many phenotypes can be identified using Chartis, what are the exact criteria to distinguish them, and how do the Chartis phenotypes respond to valve insertionκ <b><i>Methods:</i></b> In a retrospective study, 406 Chartis assessments of 166 patients with severe COPD were analyzed. Four Chartis phenotypes, CV positive (CV+), CV negative (CV-), low flow (LF) and low plateau were identified. Fifty-two patients without CV were treated with valves and followed for 3 months. <b><i>Results:</i></b> The Chartis phenotypes were discriminated with respect to decline in expiratory peak flow, increase in resistance index and change in total exhaled volume after 1, 2, 3, 4 and 5 min of measurement time (p &lt; 0.0001, ANOVA), and the cutoff criteria were defined accordingly. To examine the application of these phenotyping criteria, students applied them to 100 Chartis assessments, and they demonstrated almost perfect inter- and intraobserver agreements (κ &gt; 0.9). Compared to baseline, CV- and LF patients with ipsilateral CV- lobe showed an improvement in FEV₁ (p &lt; 0.05), vital capacity (p &lt; 0.05) and target lobe volume reduction (p &lt; 0.005) after valve insertion. <b><i>Conclusion:</i></b> This study describes the most prevalent Chartis phenotypes.

<b><i>背景：</i></b> 支气管瓣膜内镜肺减容术是重度肺气肿慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）患者的有效治疗选择。叶间侧支通气（interlobar collateral ventilation, CV）的排查情况是临床治疗成功的重要预测指标。<b><i>目的：</i></b> 近年来，基于导管的支气管内活体测量系统（Chartis，Pulmonx公司，美国）已成为临床评估靶叶CV状态的常规手段，但目前尚未明确通过Chartis评估开展CV表型分型的判定标准。本研究旨在解答以下问题：利用Chartis系统可识别出多少种CV表型？区分各表型的精确判定标准是什么？以及各类Chartis表型对瓣膜植入的响应情况如何？<b><i>方法：</i></b> 本研究为回顾性研究，共分析166例重度COPD患者的406次Chartis评估结果。最终确定了四种Chartis表型：CV阳性（CV+）、CV阴性（CV-）、低流量（LF）及低平台型。其中52例无CV的患者接受了支气管瓣膜植入治疗，并完成了3个月的随访。<b><i>结果：</i></b> 经方差分析（ANOVA）检验，在测量时长1、2、3、4及5分钟时，各Chartis表型在呼气相峰流速降低、阻力指数升高以及总呼出气量变化方面均存在显著差异（p < 0.0001），并据此明确了各表型的截断值判定标准。为验证该表型分型标准的实用性，研究学员将其应用于100次Chartis评估结果，结果显示观察者间及观察者内一致性极佳（κ > 0.9）。与基线水平相比，CV-及LF表型且同侧靶叶CV阴性的患者在瓣膜植入后，其第1秒用力呼气容积（FEV₁）、肺活量及靶叶容积缩减量均得到显著改善（FEV₁：p < 0.05；肺活量：p < 0.05；靶叶容积缩减：p < 0.005）。<b><i>结论：</i></b> 本研究明确了临床最常见的Chartis表型分型方案。