Assessment of muscular metabolism in peripheral arterial occlusive disease using 31P nuclear magnetic resonance spectroscopy. Comparison with metabolite concentrations in femoral blood.
The behaviour of muscular metabolism was investigated in 10 patients with peripheral arterial occlusive disease stage II at rest and after maximum ergometric calf exercise. The intracellular concentrations of phosphocreatine, inorganic phosphate and adenosine triphosphate as well as muscle pH were measured by means of 31P magnetic resonance spectroscopy and compared with those from a control group. In addition, arteriovenous differences in concentrations of lactate, pyruvate, ammonia, hypoxanthine and alanine in the femoral blood were determined. The fall in intracellular phosphocreatine concentration during exercise was significantly greater in the calf muscles of patients with arterial occlusion than in controls and correlated linearly with the increase in femoral arteriovenous differences in lactate, ammonia and alanine. A significant fall in intracellular pH occurred during muscular activity only in the patient group, but not in the identically exercised control group. The fall in pH correlated closely with the rise in arteriovenous lactate difference in the femoral blood. The intramuscular ATP concentration remained constant throughout the exercise procedure. The behaviour of both the directly and indirectly measured metabolites permits the deduction of activation of the creatine kinase reaction, glycolysis, myokinase reaction and the purine nucleotide cycle during exercise-induced hypoxia in the presence of arterial occlusive disease. The anaerobic production of energy is sufficient to maintain the ATP concentration even during claudication pain.(ABSTRACT TRUNCATED AT 250 WORDS)
Rexroth
W
W
Medizinische Abteilung des St. Josefskrankenhauses Heidelberg.
Semmler
W
W
Gückel
F
F
Stadtlander
M
M
Weicker
H
H
Hild
R
R
van Kaick
G
G
D000136:Acid-Base Equilibrium; D000255:Adenosine Triphosphate / Q000097:blood; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000097:blood*; D005080:Exercise Test; D006019:Glycolysis; D006801:Humans; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000378:metabolism*; D010710:Phosphates / Q000097:blood*; D010725:Phosphocreatine / Q000097:blood; D011685:Purine Nucleotides / Q000097:blood; D011773:Pyruvates / Q000097:blood; D019289:Pyruvic Acid
D007773:Lactates; D010710:Phosphates; D011685:Purine Nucleotides; D011773:Pyruvates; D010725:Phosphocreatine; D019344:Lactic Acid; D019289:Pyruvic Acid; D000255:Adenosine Triphosphate