Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism.

Full Abstract

OBJECTIVES: We aimed to investigate the pathophysiology of peripheral arterial disease (PAD) by examining magnetic resonance imaging (MRI) and spectroscopic (MRS) correlates of functional capacity. BACKGROUND: Despite the high prevalence, morbidity, and cost of PAD, its pathophysiology is incompletely understood. METHODS: Eighty-five patients (age 68 +/- 10 years) with mild-to-moderate PAD (ankle-brachial index 0.69 +/- 0.14) had their most symptomatic leg studied by MRI/MRS. Percent wall volume in the superficial femoral artery was measured with black blood MRI. First-pass contrast-enhanced MRI calf muscle perfusion and (31)P MRS phosphocreatine recovery time constant (PCr) were measured at peak exercise in calf muscle. All patients underwent magnetic resonance angiography (MRA), treadmill testing with maximal oxygen consumption measurement, and a 6-min walk test. RESULTS: Mean MRA index of number and severity of stenoses was 0.84 +/- 0.68 (normal 0), % wall volume 74 +/- 11% (normal 46 +/- 7%), tissue perfusion 0.039 +/- 0.015 s(-1) (normal 0.065 +/- 0.013 s(-1)), and PCr 87 +/- 54 s (normal 34 +/- 16 s). MRA index, % wall volume, and ankle-brachial index correlated with most functional measures. PCr was the best correlate of treadmill exercise time, whereas calf muscle perfusion was the best correlate of 6-min walk distance. No correlation was noted between PCr and tissue perfusion. CONCLUSIONS: Functional limitations in PAD are multifactorial. As measured by MRI and spectroscopy, atherosclerotic plaque burden, stenosis severity, tissue perfusion, and energetics all play a role. However, cellular metabolism is uncoupled from tissue perfusion. These findings suggest a potential role for therapies that regress plaque, increase tissue perfusion, and/or improve cellular metabolism. (Comprehensive Magnetic Resonance of Peripheral Arterial Disease; NCT00587678).

Author information

Author/s: Anderson, Justin D (JD); Epstein, Frederick H (FH); Meyer, Craig H (CH); Hagspiel, Klaus D (KD); Wang, Hongkun (H); Berr, Stuart S (SS); Harthun, Nancy L (NL); Weltman, Arthur (A); Dimaria, Joseph M (JM); West, Amy M (AM); Kramer, Christopher M (CM);

Affiliation: Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA 22908, USA.

Grants: M01 RR000847 (Agency:NCRR NIH HHS) ; R01 HL075792 (Agency:NHLBI NIH HHS) ; T32 EB003841 (Agency:NIBIB NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Journal of the American College of Cardiology (J Am Coll Cardiol), published in United States. (Language: eng)

Reference: 2009-Aug; vol 54 (issue 7) : pp 628-35

Dates: Created 2009/08/07; Completed 2009/08/31; Revised 2009/10/28;

PMID: 19660694, status: MEDLINE (last retrieval date: 10/29/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Am Coll Cardiol. 2009 Aug 11;54(7):636-7. (PMID: 19660695)

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