title: 31Phosphorus magnetic resonance spectroscopy to evaluate medical therapy efficacy in peripheral arterial disease. A pilot study.
abstract: BACKGROUND
  Human and animal studies have shown that propionyl-L-carnitine, increasing carnitine content, improves the energy metabolism of ischemic skeletal muscle. The aim of the study was to evaluate the accuracy of Doppler continuous wave, Treadmill test and 31Phosphorus magnetic resonance spectroscopy in determining the efficacy of propionyl-L-carnitine in patients with peripheral arterial disease.
  
  
  METHODS
  
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Eighteen male patients with peripheral arterial disease (category 3) and 8 healthy volunteers form the basis of the study. Patients quit smoking, start physical training (2-3 Km walk per day) and were assigned to medical therapy consisting of propionyl-L-carnitine (8 patients) or placebo (10 patients). Patients were studied with Doppler continuous wave, Treadmill test and 31Phosphorus magnetic resonance spectroscopy at day 0 and at day 90. The following parameters were assessed by the principal component analysis: clinical (absolute claudication, ankle brachial index at rest and at 2, 5 and 10 minutes after completing Treadmill exercises) and biochemical (inorganic phosphorus/phosphocreatine ratio and pH profiles at 20% and 50% of the maximum load, the recovery half time of phosphocreatine, number of exercise steps and slope of linear relationship between muscle power and inorganic phosphorus/phosphocreatine ratio).
  
  
  RESULTS
  Final evaluation showed a significant improvement of clinical and biochemical variables (p < 0.05 and p < 0.02 respectively). Breaking down the results on the basis of the two study arms, 31Phosphorus magnetic resonance spectroscopy showed a significant improvement of biochemical variables in the group of patients treated with propionyl-L-carnitine (p < 0.05) and was more sensitive in the evaluation of changes induced by 90-day treatment as compared with the other noninvasive examinations.
  
  
  CONCLUSIONS
  31P-MRS permits the evaluation of muscle metabolic effect induced by PLC after a 90-day-period in patients affected by category 3 of peripheral arterial disease and it is a more sensitive tool in the evaluation of the pharmacological effects of medical therapy.
authors.affiliation: 1st Department of Surgery, University of Rome La Sapienza, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Di Marzo
authors.forename: A
authors.initials: A
authors.lastname: Miccheli
authors.forename: P
authors.initials: P
authors.lastname: Sapienza
authors.forename: M
authors.initials: M
authors.lastname: Tedesco
authors.forename: A
authors.initials: A
authors.lastname: Mingoli
authors.forename: G
authors.initials: G
authors.lastname: Capuani
authors.forename: T
authors.initials: T
authors.lastname: Aureli
authors.forename: A
authors.initials: A
authors.lastname: Giuliani
authors.forename: F
authors.initials: F
authors.lastname: Conti
authors.forename: A
authors.initials: A
authors.lastname: Cavallaro
mesh_terms: D000368:Aged; D000818:Animals; D002331:Carnitine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects / Q000378:metabolism; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000378:metabolism*; D010758:Phosphorus
chemical_list: C003223:propionylcarnitine; D010758:Phosphorus; D002331:Carnitine