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Delayed Calf Muscle Phosphocreatine Recovery After Exercise Identifies Peripheral Arterial Disease

David C. Isbell, MD^_*, Stuart S. Berr, PhD^,, Alicia Y. Toledano, ScD^||, Frederick H. Epstein, PhD^,, Craig H. Meyer, PhD, Walter J. Rogers, PhD^_*,, Nancy L. Harthun, MD, Klaus D. Hagspiel, MD, Arthur Weltman, PhD^_* and Christopher M. Kramer, MD^_*,,_*

^_* Medicine
Radiology
Biomedical Engineering
Surgery, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
^|| Center for Statistical Sciences, Brown University, Providence, Rhode Island

View larger version (10K): [in a new window]   Figure 1 Sequential phosphorous-31 spectra acquired after exercise in a subject with peripheral arterial disease. In this example the first three spectra (45 s) after exercise are shown. Note the incremental increase in phosphocreatine (PCr) and simultaneous decrease in inorganic phosphate reflecting PCr regeneration in the skeletal muscle tissue. ATP = adenosine triphosphate; PDE = phosphodiester; Pi = inorganic phosphate; PME = phosphomonester.

View larger version (10K): [in a new window]   Figure 2 Representative phosphocreatine (PCr) recovery plots in control (top) and peripheral arterial disease (bottom) subjects. Note the steeper recovery curve in the control subject. The PCr recovery time constant was 34.4 s in the control subject and 121.1 s in the peripheral arterial disease patient.

View larger version (19K): [in a new window]   Figure 3 In this graph of phosphocreatine (PCr) recovery time constants, the boxes extend from the 25th to the 75th percentile, and the horizontal lines depict the medians. The median PCr recovery time constant is longer in peripheral arterial disease (PAD) patients.

View larger version (12K): [in a new window]   Figure 4 Receiver-operating characteristic curve for phosphocreatine (PCr) recovery kinetics. The points shown are the observed data.

View larger version (16K): [in a new window]   Figure 5 Reproducibility analyzed using the method of Bland and Altman.