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> 经支气管瓣膜肺减容术是治疗重度肺气肿慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）患者的有效治疗手段。排除叶间侧支通气（CV）是预测手术临床成功的重要指标。<b><i>目的：</i></b> 目前，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侧支通气（CV）状态的常规手段，但通过Chartis评估进行CV表型分型的标准尚未明确。本研究旨在明确三个核心问题：利用Chartis可识别出多少种CV表型？区分这些表型的具体标准是什么？Chartis表型在瓣膜植入后会呈现何种响应？<b><i>方法：</i></b> 本回顾性研究共分析了166例重度COPD患者的406次Chartis评估结果。最终确定了4种Chartis CV表型：侧支通气阳性（CV+）、侧支通气阴性（CV-）、低流量（LF）以及低平台（low plateau）。其中52例无CV的患者接受了瓣膜植入治疗，并进行了为期3个月的随访。<b><i>结果：</i></b> 经方差分析（ANOVA）显示，在测量时长1、2、3、4、5分钟时，不同Chartis表型的呼气峰流速下降幅度、阻力指数升高幅度以及总呼出气量变化均存在显著差异（p < 0.0001），并据此确定了分型截断标准。为验证该分型标准的应用效果，研究人员将其应用于100次Chartis评估结果，结果显示评估者间与评估者内一致性近乎完美（κ > 0.9）。与基线水平相比，靶叶为同侧CV-的CV-及LF患者在瓣膜植入后，其一秒用力呼气容积（Forced Expiratory Volume in 1 second, FEV₁）、肺活量均得到改善（p < 0.05），靶叶体积也出现显著缩小（p < 0.005）。<b><i>结论：</i></b> 本研究明确了临床最常见的Chartis CV表型分型体系。