CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Marc Dewey, MD, PhD*
* Charité–Universitätsmedizin Berlin, Institut für Radiologie, Charitéplatz 1, 10117 Berlin, Germany (Email: marc.dewey{at}charite.de).
In their response to the paper by Anderson et al. (1) and my editorial comment (2), Dr. Abraham and colleagues make an important point in highlighting the importance of "nondownstream" factors in peripheral artery disease. The fact that cellular metabolism was the parameter that correlated best with the clinically most relevant treadmill exercise results in the study by Anderson et al. (1) supports the potential influence of other factors such as proximal claudication, anemia, and hypoxemia. The common features in the etiology of atherosclerosis and pulmonary disease may be a key factor here; for instance, peripheral artery disease and coronary artery disease are more common in moderate and heavy cigarette smokers than in never smokers (3). Further analyses of, for example, anemia (by measurements of hemoglobin) may have shed more light (4) on the pathophysiological interactions and correlation with magnetic resonance imaging parameters in the study by Anderson et al. (1). Nevertheless, their study is a great step forward on the path of developing a clinically meaningful use of imaging (5). Finally, I would like to remind everybody that it is impossible to achieve all that is possible in a single clinical study.
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1. Anderson JD, Epstein FH, Meyer CH, et al. Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism J Am Coll Cardiol 2009;54:628-635.[Abstract/Free Full Text]2. Dewey M. Comprehensive assessment of peripheral artery disease using magnetic resonance imaging, angiography, and spectroscopy J Am Coll Cardiol 2009;54:636-637.[Free Full Text] 3. Price JF, Mowbray PI, Lee AJ, Rumley A, Lowe GD, Fowkes FG. Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study Eur Heart J 1999;20:344-353.[Abstract/Free Full Text] 4. Dijk JM, Wangge G, Graaf Y, Bots ML, Grobbee DE, Algra A. Hemoglobin and atherosclerosis in patients with manifest arterial disease. The SMART study. Atherosclerosis 2006;188:444-449.[CrossRef][Web of Science][Medline] 5. Braunwald E. Epilogue: what do clinicians expect from imagers? J Am Coll Cardiol 2006;47:C101-C103.[Free Full Text]
Related Article
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Determinants of Functional Capacity in Peripheral Arterial Disease
- Pierre Abraham, Guillaume Mahé, Antoine Bruneau, and Georges Leftheriotis
J. Am. Coll. Cardiol. 2010 55: 609-610.
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