Multifactorial Determinants of Functional Capacity in Peripheral Arterial Disease. Uncoupling of Calf Muscle Perfusion and Metabolism

Justin D. Anderson, Frederick H. Epstein, Craig H. Meyer, Klaus D. Hagspiel, Hongkun Wang, Stuart S. Berr, Nancy L. Harthun, Arthur Weltman, Joseph M. DiMaria, Amy M. West, Christopher M. Kramer

Research output: Contribution to journalArticle

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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 31P 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).

Original languageEnglish (US)
Pages (from-to)628-635
Number of pages8
JournalJournal of the American College of Cardiology
Volume54
Issue number7
DOIs
StatePublished - Aug 11 2009
Externally publishedYes

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Peripheral Arterial Disease
Perfusion
Muscles
Magnetic Resonance Imaging
Magnetic Resonance Angiography
Ankle Brachial Index
Pathologic Constriction
Magnetic Resonance Spectroscopy
Exercise
Phosphocreatine
Atherosclerotic Plaques
Femoral Artery
Oxygen Consumption
Leg
Morbidity
Costs and Cost Analysis

Keywords

  • atherosclerosis
  • blood flow
  • magnetic resonance imaging
  • peripheral vascular disease
  • spectroscopy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Multifactorial Determinants of Functional Capacity in Peripheral Arterial Disease. Uncoupling of Calf Muscle Perfusion and Metabolism. / Anderson, Justin D.; Epstein, Frederick H.; Meyer, Craig H.; Hagspiel, Klaus D.; Wang, Hongkun; Berr, Stuart S.; Harthun, Nancy L.; Weltman, Arthur; DiMaria, Joseph M.; West, Amy M.; Kramer, Christopher M.

In: Journal of the American College of Cardiology, Vol. 54, No. 7, 11.08.2009, p. 628-635.

Research output: Contribution to journalArticle

Anderson, JD, Epstein, FH, Meyer, CH, Hagspiel, KD, Wang, H, Berr, SS, Harthun, NL, Weltman, A, DiMaria, JM, West, AM & Kramer, CM 2009, 'Multifactorial Determinants of Functional Capacity in Peripheral Arterial Disease. Uncoupling of Calf Muscle Perfusion and Metabolism', Journal of the American College of Cardiology, vol. 54, no. 7, pp. 628-635. https://doi.org/10.1016/j.jacc.2009.01.080
Anderson, Justin D. ; Epstein, Frederick H. ; Meyer, Craig H. ; Hagspiel, Klaus D. ; Wang, Hongkun ; Berr, Stuart S. ; Harthun, Nancy L. ; Weltman, Arthur ; DiMaria, Joseph M. ; West, Amy M. ; Kramer, Christopher M. / Multifactorial Determinants of Functional Capacity in Peripheral Arterial Disease. Uncoupling of Calf Muscle Perfusion and Metabolism. In: Journal of the American College of Cardiology. 2009 ; Vol. 54, No. 7. pp. 628-635.
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AU - Anderson, Justin D.

AU - Epstein, Frederick H.

AU - Meyer, Craig H.

AU - Hagspiel, Klaus D.

AU - Wang, Hongkun

AU - Berr, Stuart S.

AU - Harthun, Nancy L.

AU - Weltman, Arthur

AU - DiMaria, Joseph M.

AU - West, Amy M.

AU - Kramer, Christopher M.

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N2 - 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 31P 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).

AB - 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 31P 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).

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KW - blood flow

KW - magnetic resonance imaging

KW - peripheral vascular disease

KW - spectroscopy

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