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Panminerva Medica 1999 December;41(4):283-90


lingua: Inglese

31Phosphorus magnetic resonance spectroscopy to evaluate medical therapy efficacy in peripheral arterial disease. A pilot study

Di Marzo L., Miccheli A.*, Sapienza P., Tedesco M., Mingoli A., Capuani G.*, Aureli T.*, Giuliani A.*, Conti F.*, Cavallaro A.

From the 1st Department of Surgery and * Department of Chemistry University of Rome “La Sapienza”, Rome, Italy


Background. Human and ani­mal stud­ies ­have ­shown ­that pro­pi­o­nyl-L-car­ni­tine, increas­ing car­ni­tine con­tent, ­improves the ener­gy metab­olism of ischem­ic skel­e­tal mus­cle. The aim of the ­study was to eval­u­ate the accu­ra­cy of Doppler con­tin­u­ous ­wave, Treadmill ­test and 31Phosphorus mag­net­ic res­o­nance spec­tros­co­py in deter­min­ing the effi­ca­cy of pro­pi­o­nyl-L-car­ni­tine in ­patients ­with periph­er­al arte­ri­al dis­ease.
Methods. Experimental ­design: Prospective ­study. Setting: University hos­pi­tal. Patients: Eighteen ­male ­patients ­with periph­er­al arte­ri­al dis­ease (cat­e­go­ry 3) and 8 ­healthy vol­un­teers ­form the ­basis of the ­study. Patients ­quit smok­ing, ­start phys­i­cal train­ing (2-3 Km ­walk per day) and ­were ­assigned to med­i­cal ther­a­py con­sist­ing of pro­pi­o­nyl-L-car­ni­tine (8 ­patients) or pla­ce­bo (10 ­patients). Patients ­were stud­ied ­with Doppler con­tin­u­ous ­wave, Treadmill ­test and 31Phosphorus mag­net­ic res­o­nance spec­tros­co­py at day 0 and at day 90. The fol­low­ing param­e­ters ­were ­assessed by the prin­ci­pal com­po­nent anal­y­sis: clin­i­cal (abso­lute claud­i­ca­tion, ­ankle bra­chi­al ­index at ­rest and at 2, 5 and 10 min­utes ­after com­plet­ing Treadmill exer­cis­es) and bio­chem­i­cal (inor­gan­ic phos­phor­us/phos­pho­crea­tine ­ratio and pH pro­files at 20% and 50% of the max­i­mum ­load, the recov­ery ­half ­time of phos­pho­crea­tine, num­ber of exer­cise ­steps and ­slope of lin­e­ar rela­tion­ship ­between mus­cle pow­er and inor­gan­ic phos­phor­us/phos­pho­crea­tine ­ratio).
Results. Final eval­u­a­tion ­showed a sig­nif­i­cant improve­ment of clin­i­cal and bio­chem­i­cal var­i­ables (p<0.05 and p<0.02 respec­tive­ly). Breaking ­down the ­results on the ­basis of the two ­study ­arms, 31Phosphorus mag­net­ic res­o­nance spec­tros­co­py ­showed a sig­nif­i­cant improve­ment of bio­chem­i­cal var­i­ables in the ­group of ­patients treat­ed ­with pro­pi­o­nyl-L-car­ni­tine (p<0.05) and was ­more sen­si­tive in the eval­u­a­tion of chang­es ­induced by 90-day treat­ment as com­pared ­with the oth­er non­in­va­sive exam­ina­tions.
Conclusions. 31P-MRS per­mits the eval­u­a­tion of mus­cle meta­bol­ic ­effect ­induced by PLC ­after a 90-day-peri­od in ­patients affect­ed by cat­e­go­ry 3 of periph­er­al arte­ri­al dis­ease and it is a ­more sen­si­tive ­tool in the eval­u­a­tion of the phar­mac­o­log­i­cal ­effects of med­i­cal ther­a­py.

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