Circulation, Vol 87, 413-421, Copyright © 1993 by American Heart Association
JG Regensteiner, EE Wolfel, EP Brass, MR Carry, SP Ringel, ME Hargarten, ER Stamm and WR Hiatt
BACKGROUND. Peripheral arterial disease (PAD) is associated with an
impairment in exercise performance and muscle function that is not fully
explained by the reduced leg blood flow during exercise. This study
characterized the effects of PAD on muscle function, histology, and
metabolism. METHODS AND RESULTS. Twenty-six patients with PAD and six
age-matched control subjects were studied. Ten of the PAD patients had
unilateral disease, which permitted paired comparisons between their
diseased and nonsymptomatic legs. All PAD patients had a lower peak
treadmill walking time and peak oxygen consumption than controls. Vascular
disease (diseased leg in unilateral patients and the most severely diseased
leg in bilateral patients) was associated with decreased calf muscle
strength compared with control values. In patients with unilateral disease,
the diseased legs had a greater percentage of angular fibers (indicating
chronic denervation) and a decreased type II fiber cross-sectional area
(expressed as percent of total fiber area) compared with the
nonsymptomatic, or control, legs. In diseased legs, gastrocnemius muscle
strength was correlated with the total calf cross-sectional area (r = 0.78,
p < 0.05) and type II fiber cross-sectional area (r = 0.63, p <
0.05). Activities of citrate synthase, phosphofructokinase, and lactate
dehydrogenase in all 26 PAD patients (most diseased leg) did not differ
from control values. Despite a wide range in citrate synthase activity in
PAD patients, activity of this enzyme was not correlated with muscle
strength or treadmill exercise performance. CONCLUSIONS. In patients with
PAD, gastrocnemius muscle weakness is associated with muscle fiber
denervation and a decreased type II fiber cross-sectional area. In
contrast, the PAD patients displayed substantial heterogeneity in muscle
enzyme activities that was not associated with exercise performance.
Denervation and type II fiber atrophy may contribute to the muscle
dysfunction in patients with PAD and further confirm that the
pathophysiology of chronic PAD extends beyond arterial obstruction.
ARTICLES
Chronic changes in skeletal muscle histology and function in peripheral arterial disease
Department of Medicine, University of Colorado School of Medicine, Denver.
This article has been cited by other articles:
 |
|
 |
|
  M. M. McDermott, L. Ferrucci, J. Guralnik, L. Tian, K. Liu, F. Hoff, Y. Liao, and M. H. Criqui Pathophysiological Changes in Calf Muscle Predict Mobility Loss at 2-Year Follow-Up in Men and Women With Peripheral Arterial Disease Circulation, September 22, 2009; 120(12): 1048 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. I. Pipinos, A. R. Judge, J. T. Selsby, Zhen Zhu, S. A. Swanson, A. A. Nella, and S. L. Dodd Basic Science Review: The Myopathy of Peripheral Arterial Occlusive Disease: Part 2. Oxidative Stress, Neuropathy, and Shift in Muscle Fiber Type Vascular and Endovascular Surgery, May 1, 2008; 42(2): 101 - 112. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Arseven, J. M. Guralnik, E. O'Brien Kaleba, K. Liu, C. Chan, and M. McGrae McDermott Does Lower-Extremity Arterial Disease Predict Future Falling Among Older Men and Women? Angiology, January 1, 2008; 58(6): 725 - 733. [Abstract] [PDF]
|
|
|
|
 |
|
 E. P Brass, W. R Hiatt, and S. Green Skeletal muscle metabolic changes in peripheral arterial disease contribute to exercise intolerance: a point-counterpoint discussion Vascular Medicine, November 1, 2004; 9(4): 293 - 301. [Abstract] [PDF]
|
|
|
|
 |
|
 M. M. McDermott, K. Liu, P. Greenland, J. M. Guralnik, M. H. Criqui, C. Chan, W. H. Pearce, J. R. Schneider, L. Ferrucci, L. Celic, et al. Functional Decline in Peripheral Arterial Disease: Associations With the Ankle Brachial Index and Leg Symptoms JAMA, July 28, 2004; 292(4): 453 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Atkins and A. W. Gardner The Relationship Between Lower Extremity Functional Strength and Severity of Peripheral Arterial Disease Angiology, July 1, 2004; 55(4): 347 - 355. [Abstract] [PDF]
|
|
|
|
|
|
D. P. Faxon, V. Fuster, P. Libby, J. A. Beckman, W. R. Hiatt, R. W. Thompson, J. N. Topper, B. H. Annex, J. H. Rundback, R. P. Fabunmi, et al. Atherosclerotic Vascular Disease Conference: Writing Group III: Pathophysiology Circulation, June 1, 2004; 109(21): 2617 - 2625. [Full Text] [PDF]
|
|
|
|
 |
|
 L. T. Cooper Beraprost for the treatment of intermittent claudication J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1687 - 1689. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Takahashi, Y. Kureishi, J. Yang, Z. Luo, K. Guo, D. Mukhopadhyay, Y. Ivashchenko, D. Branellec, and K. Walsh Myogenic Akt Signaling Regulates Blood Vessel Recruitment during Myofiber Growth Mol. Cell. Biol., July 1, 2002; 22(13): 4803 - 4814. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. McDermott, P. Greenland, K. Liu, J. M. Guralnik, L. Celic, M. H. Criqui, C. Chan, G. J. Martin, J. Schneider, W. H. Pearce, et al. The Ankle Brachial Index Is Associated with Leg Function and Physical Activity: The Walking and Leg Circulation Study Ann Intern Med, June 18, 2002; 136(12): 873 - 883. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Chroni, V. Papapetropoulou, J. Tsolakis, S. Terzis, C. Paschalis, T. Papapetropoulos, D. H. Weinberg, D. Simovic, and A. Ropper Chronic ischemic monomelic neuropathy from critical limb ischemia Neurology, June 11, 2002; 58(11): 1705 - 1706. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Condorelli and G. Brevetti Intermittent claudication: an historical perspective Eur. Heart J. Suppl., March 1, 2002; 4(suppl_B): B2 - B7. [Abstract] [PDF]
|
|
|
|
|
|
D. H. Weinberg, D. Simovic, J. Isner, and A. H. Ropper Chronic ischemic monomelic neuropathy from critical limb ischemia Neurology, September 25, 2001; 57(6): 1008 - 1012. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. M. McGuigan, R. Bronks, R. U. Newton, M. J. Sharman, J. C. Graham, D. V. Cody, and W. J. Kraemer Resistance Training in Patients With Peripheral Arterial Disease: Effects on Myosin Isoforms, Fiber Type Distribution, and Capillary Supply to Skeletal Muscle J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2001; 56(7): B302 - 310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Scott-Okafor, K. K. C. Silver, J. Parker, T. Almy-Albert, and A. W. Gardner Lower Extremity Strength Deficits in Peripheral Arterial Occlusive Disease Patients with Intermittent Claudication Angiology, January 1, 2001; 52(1): 7 - 14. [Abstract] [PDF]
|
|
|
|
 |
|
 D. H. Cherwek, M. B. Hopkins, M. J. Thompson, B. H. Annex, and D. A. Taylor Fiber type-specific differential expression of angiogenic factors in response to chronic hindlimb ischemia Am J Physiol Heart Circ Physiol, September 1, 2000; 279(3): H932 - H938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Back, H. A. Kluess, T. S. Huber, C. B. Stopka, K. N. Scott, J. R. Ballinger, M. A. Welsch, A. P. Bruner, T. Lyles, T. R. S. Harward, et al. Evaluation of Skeletal Muscle Metabolic Responses Following Exercise Training in Patients with Intermittent Claudication Vascular and Endovascular Surgery, July 1, 2000; 34(4): 345 - 359. [Abstract] [PDF]
|
|
|
|
 |
|
 T. A. Bauer, J. G. Regensteiner, E. P. Brass, and W. R. Hiatt Oxygen uptake kinetics during exercise are slowed in patients with peripheral arterial disease J Appl Physiol, August 1, 1999; 87(2): 809 - 816. [Abstract] [Full Text] [PDF]
|
|