Abstract
We assessed whether muscle metabolism biomarkers (MMb) identified by near-infrared spectroscopy (NIRS) are valid for determining adaptations following revascularization or exercise training in peripheral artery disease (PAD). Eighteen patients (males n = 13; 69 ± 7 years) were randomized to receive revascularization (Rev = 6) or pain-free home-based exercise (Ex = 12). MMb were safely collected via a NIRS-assisted treadmill test as area-under-curve for the spectra of oxygenated (-oxy), deoxygenated (-deoxy), differential (-diff) and total (-tot) hemoglobin traces. MMb, ankle–brachial index (ABI), pain-free (PFWD) and 6-min (6MWD) walking distances were assessed at baseline and after four months. MMb were correlated at baseline with ABI (MMb-oxy r = 0.46) and 6MWD (MMb-tot r = 0.51). After treatments, MMb-oxy showed an expected increase, which was more relevant for Rev group than the Ex (56% vs. 20%), with trends towards normalization for the other MMb. These changes were significantly correlated with variations in ABI (MMb-oxy r = 0.71; p = 0.002) and 6MWD (MMb-tot r = 0.58; p = 0.003). The MMb-diff in Rev group and MMb-deoxy in Ex group at baseline predicted clinical outcomes being correlated with PFWD improvements after 4-month (r = −0.94; p = 0.005 and r = −0.57; p = 0.05, respectively). A noninvasive NIRS-based test, feasible in a clinical setting, identified muscle metabolism biomarkers in PAD. The novel MMb were associated with validated outcome measures, selectively modified after different interventions and able to predict long-term functional improvements after surgery or exercise training.
Highlights
Peripheral artery disease (PAD) affects millions of people worldwide, elderly individuals [1,2]
The aim of the study was to determine whether muscle metabolism biomarkers (MMb) identified by a near-infrared spectroscopy (NIRS)-based treadmill test [22] performed in a clinical setting are potentially suitable to quantify muscle adaptations in PAD
The two groups did not differ at baseline in terms of anthropometrics, comorbidities, hemodynamics, performance or muscle metabolism parameters assessed by NIRS (Table 1)
Summary
Peripheral artery disease (PAD) affects millions of people worldwide, elderly individuals [1,2]. In a high percentage of cases, patients suffer from reduced mobility due to the presence of limiting symptoms such as claudication or exertional pain [1]. Hemodynamic severity and functional capacity are generally assessed in clinical practice by the ankle–brachial index (ABI) and treadmill or ground walking tests, which estimate patients’ peripheral blood supply and walking capability, respectively [3,5]. These validated measures are used to evaluate hemodynamic and functional outcomes after rehabilitation or revascularization [4]. In addition new methods proposed may detect changes in muscle perfusion muscles after revascularization of the lower limbs, such as positron emission tomography, magnetic resonance imaging or the ASL technique [3,10,11,12,13]
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