title: Superficial femoral artery plaque and functional performance in peripheral arterial disease: walking and leg circulation study (WALCS III).
abstract: OBJECTIVE
  We studied associations of magnetic resonance imaging measurements of plaque area and relative percent lumen reduction in the proximal superficial femoral artery with functional performance among participants with peripheral arterial disease.
  
  
  BACKGROUND
  The clinical significance of directly imaged plaque characteristics in lower extremity arteries is not well established.
  
  
  METHODS
  A total of 454 participants with an ankle brachial index <1.00 underwent magnetic resonance cross-sectional imaging of the proximal superficial femoral artery and completed a 6-min walk test, measurement of 4-m walking velocity at usual and fastest pace, and measurement of physical activity with a vertical accelerometer.
  
  
  RESULTS
  Adjusting for age, sex, race, body mass index, smoking, statin use, comorbidities, and other covariates, higher mean plaque area (1st quintile [least plaque]: 394 m, 2nd quintile: 360 m, 3rd quintile: 359 m, 4th quintile: 329 m, 5th quintile [greatest plaque]: 311 m; p trend <0.001) and smaller mean percent lumen area (1st quintile [greatest plaque]: 319 m, 2nd quintile: 330 m, 3rd quintile: 364 m, 4th quintile: 350 m, 5th quintile: 390 m; p trend <0.001) were associated with shorter distance achieved in the 6-min walk test. Greater mean plaque area was also associated with slower usual-paced walking velocity (p trend = 0.006) and slower fastest-paced 4-m walking velocity (p trend = 0.003). Associations of mean plaque area and mean lumen area with 6-min walk distance remained statistically significant even after additional adjustment for the ankle brachial index and leg symptoms.
  
  
  CONCLUSIONS
  Among participants with peripheral arterial disease, greater plaque burden and smaller lumen area in the proximal superficial femoral artery are associated independently with poorer functional performance, even after adjusting for the ankle brachial index and leg symptoms.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. mdm608@northwestern.edu
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Carroll
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Debiao
authors.initials: D
authors.lastname: Li
authors.forename: James
authors.initials: J
authors.lastname: Carr
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Melina
authors.initials: M
authors.lastname: Kibbe
authors.forename: William H
authors.initials: WH
authors.lastname: Pearce
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
authors.forename: Walter
authors.initials: W
authors.lastname: McCarthy
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.forename: Huimin
authors.initials: H
authors.lastname: Tao
authors.forename: Yihua
authors.initials: Y
authors.lastname: Liao
authors.forename: Elizabeth Talley
authors.initials: ET
authors.lastname: Clark
authors.forename: Dongxiang
authors.initials: D
authors.lastname: Xu
authors.forename: Jarett
authors.initials: J
authors.lastname: Berry
authors.forename: Jennifer
authors.initials: J
authors.lastname: Orozco
authors.forename: Leena
authors.initials: L
authors.lastname: Sharma
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
mesh_terms: D056044:Actigraphy; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D016009:Chi-Square Distribution; D002641:Chicago; D003251:Constriction, Pathologic; D005080:Exercise Test; D005260:Female; D005263:Femoral Artery / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D013997:Time Factors; D016138:Walking