Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism.
OBJECTIVE
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).
Anderson
Justin D
JD
Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA 22908, USA.
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
D000328:Adult; D000368:Aged; D005080:Exercise Test; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology; D007866:Leg / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000378:metabolism* / Q000503:physiopathology; D016491:Peripheral Vascular Diseases / Q000378:metabolism / Q000503:physiopathology*; D010725:Phosphocreatine / Q000031:analogs & derivatives / Q000378:metabolism; D012039:Regional Blood Flow
D010725:Phosphocreatine; C025403:phosphocreatinine