有症状的下肢外周动脉疾病患者步行运动后骨骼肌灌注与能量代谢

Post-walking exercise skeletal muscle perfusion and energetics in patients with symptomatic lower extremity peripheral artery disease.

作者信息

Divakaran Sanjay, Harms Hendrik J, Robertson Matthew, Merugumala Sai K, Park Mi-Ae, Kijewski Marie F, Martell Laurel B, Morgan Victoria, Barrett Leanne, Perillo Anna, Yang David, Jarolim Petr, Feinberg Mark W, Gerhard-Herman Marie D, Belkin Michael, Lin Alexander P, Creager Mark A, Bonaca Marc P, Di Carli Marcelo F

机构信息

Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

J Nucl Cardiol. 2025 Apr;46:102143. doi: 10.1016/j.nuclcard.2025.102143. Epub 2025 Jan 30.

DOI:10.1016/j.nuclcard.2025.102143

PMID:39889951

Abstract

BACKGROUND

The pathophysiology of symptoms and reduced exercise capacity from peripheral artery disease (PAD) remains unclear. Additionally, there is limited information on blood flow and skeletal muscle energetics after walking exercise in patients with claudication in comparison to healthy individuals.

METHODS

We prospectively enrolled 19 patients with claudication from PAD and 12 healthy subjects. All participants underwent rest and post-exercise perfusion imaging of the lower leg muscles via PET/CT. Participants exercised on a treadmill following the Gardner-Skinner protocol. Skeletal muscle blood flow (SMBF) was quantified in each leg at rest and immediately after exercise. Phosphocreatine (PCr) recovery and NAD/NADH concentrations were measured pre- and post-exercise by P magnetic resonance spectroscopy (MRS) in a subset of participants. Comparisons were made between the legs of healthy subjects and the asymptomatic and symptomatic legs of patients with PAD.

RESULTS

SMBF increased post-exercise in all participants. Among patients with PAD, the post-exercise/rest SMBF ratio, was higher in the symptomatic (n = 25) than asymptomatic (n = 13) legs (8.03 ± 2.84 vs 6.03 ± 2.81, P = 0.046) and higher than the post-exercise/rest SMBF ratio measured in the legs of healthy subjects (4.40 ± 1.47, P < 0.001). The post-exercise/rest PCr and NAD/NADH ratios were lower in the legs of patients with PAD (n = 3) when compared with the legs of healthy subjects (n = 6) (0.79 ± 0.06 vs 1.00 ± 0.07 (P = 0.004) and 1.15 ± 0.43 vs 2.08 ± 0.30 (P = 0.007), respectively).

CONCLUSIONS

SMBF increased post-exercise to the greatest degree in the symptomatic legs of patients with PAD and post-exercise skeletal muscle mitochondrial function was abnormal in patients with PAD. These data suggest that the causes of symptoms and reduced exercise capacity from PAD are not limited to abnormal perfusion pressure in the legs.

摘要

背景

外周动脉疾病（PAD）症状的病理生理学以及运动能力下降的原因仍不清楚。此外，与健康个体相比，有关间歇性跛行患者步行运动后血流和骨骼肌能量代谢的信息有限。

方法

我们前瞻性招募了19例PAD间歇性跛行患者和12名健康受试者。所有参与者均通过PET/CT对小腿肌肉进行静息和运动后灌注成像。参与者按照Gardner-Skinner方案在跑步机上进行运动。在静息状态和运动后立即对每条腿的骨骼肌血流量（SMBF）进行量化。在一部分参与者中，通过磷磁共振波谱（MRS）测量运动前后的磷酸肌酸（PCr）恢复情况以及NAD/NADH浓度。对健康受试者的双腿以及PAD患者无症状和有症状的腿进行比较。

结果

所有参与者运动后SMBF均增加。在PAD患者中，有症状的腿（n = 25）运动后/静息SMBF比值高于无症状的腿（n = 13）（8.03±2.84 vs 6.03±2.81，P = 0.046），且高于健康受试者腿部的运动后/静息SMBF比值（4.40±1.47，P < 0.001）。与健康受试者的腿（n = 6）相比，PAD患者的腿（n = 3）运动后/静息PCr和NAD/NADH比值较低（分别为0.79±0.06 vs 1.00±0.07（P = 0.004）和1.15±0.43 vs 2.08±0.30（P = 0.007））。