Multifactorial Determinants of Functional Capacity in Peripheral Arterial DiseaseUncoupling of Calf Muscle Perfusion and Metabolism
Justin D. Anderson, MD*,
Frederick H. Epstein, PhD , ,
Craig H. Meyer, PhD,,
Klaus D. Hagspiel, MD*,,
Hongkun Wang, PhD ,
Stuart S. Berr, PhD,,
Nancy L. Harthun, MD||,
Arthur Weltman, PhD*,
Joseph M. DiMaria, BA,
Amy M. West, MD* and
Christopher M. Kramer, MD*,,*
* Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
Department of Public Health Sciences, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
|| Department of Surgery, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
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Figure 1 MR Plaque and Calf Muscle Perfusion Images, MR Angiogram, and MRS Phosphocreatine Recovery Curve All From the Same Patient With PAD
(A) High resolution black blood magnetic resonance (MR) image of the superficial femoral artery in cross section. The vessel lumen is denoted by a gray arrow and the vessel wall by a black arrow. Note the large amount of atherosclerotic plaque in the vessel wall. (B) MR angiogram of the superficial femoral artery. The arrow denotes a severe stenosis in the proximal left superficial femoral artery, which corresponds to the vessel wall image in A. (C) Post-exercise contrast-enhanced peak perfusion of the calf muscle in cross section. Note the heterogeneous signal intensity. Arrows depict the muscle groups (anterior tibialis and soleus muscles) with the greatest contrast enhancement (i.e., perfusion). (D) The graph is a plot of phosphocreatine recovery with relative phosphocreatine concentration on the y axis and time in seconds on the x axis. The phosphocreatine recovery time constant (PCr) is calculated using a mono-exponential fit of this data. MRS = magnetic resonance spectroscopy; PAD = peripheral arterial disease.
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Figure 2 Lack of Correlation Between PCr and Perfusion
Correlation between phosphocreatine recovery time constant (PCr) and tissue perfusion demonstrating the lack of significant relationship between the 2 parameters (y = 7.52 x 10–6 x +0.38, r = 0.02, p = 0.82).
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Figure 3 Correlation Between Perfusion and 6-Min Walk
Correlation demonstrating positive relationship between tissue perfusion and 6-min walk distance (y = 8857 x +672, r = 0.32, p < 0.01).
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Figure 4 Correlation Between PCr and Exercise Time
Correlation demonstrating the inverse relationship between phosphocreatine recovery time constant (PCr) and treadmill exercise time (y = –2.1 x +680, r = –0.22, p < 0.05).
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