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. 2007 Mar;55(3):400-6.
doi: 10.1111/j.1532-5415.2007.01092.x.

Lower extremity ischemia, calf skeletal muscle characteristics, and functional impairment in peripheral arterial disease

Mary M McDermott  1 , Frederick Hoff, Luigi Ferrucci, William H Pearce, Jack M Guralnik, Lu Tian, Kiang Liu, Joseph R Schneider, Leena Sharma, Jin Tan, Michael H Criqui
Affiliations

Lower extremity ischemia, calf skeletal muscle characteristics, and functional impairment in peripheral arterial disease

Mary M McDermott et al. J Am Geriatr Soc. 2007 Mar.

Abstract

Objectives: To determine whether lower ankle brachial index (ABI) levels are associated with lower calf skeletal muscle area and higher calf muscle percentage fat in persons with and without lower extremity peripheral arterial disease (PAD).

Design: Cross-sectional.

Setting: Three Chicago-area medical centers.

Participants: Four hundred thirty-nine persons with PAD (ABI<0.90) and 265 without PAD (ABI 0.90-1.30).

Measurements: Calf muscle cross-sectional area and the percentage of fat in calf muscle were measured using computed tomography at 66.7% of the distance between the distal and proximal tibia. Physical activity was measured using an accelerometer. Functional measures included the 6-minute walk, 4-meter walking speed, and the Short Physical Performance Battery (SPPB).

Results: Adjusting for age, sex, race, comorbidities, and other potential confounders, lower ABI values were associated with lower calf muscle area (ABI<0.50, 5,193 mm(2); ABI 0.50-0.90, 5,536 mm(2); ABI 0.91-1.30, 5,941 mm(2); P for trend<.001). These significant associations remained after additional adjustment for physical activity. In participants with PAD, lower calf muscle area in the leg with higher ABI was associated with significantly poorer performance in usual- and fast-paced 4-meter walking speed and on the SPPB, adjusting for ABI, physical activity, percentage fat in calf muscle, muscle area in the leg with lower ABI, and other confounders (P<.05 for all comparisons).

Conclusion: These data support the hypothesis that lower extremity ischemia has a direct adverse effect on calf skeletal muscle area. This association may mediate previously established relationships between PAD and functional impairment.

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Figures

Figure 1
Figure 1
Calf skeletal muscle area according to ankle brachial index (ABI) in men and women aged 59 and older who wore an activity monitor (n =523). Model 1 adjusts for age, sex, race, comorbidities, body mass index, tibia length, and smoking history. Model 2 adjusts for Model 1 covariates plus physical activity measured using a pedometer. Model 3 adjusts for Model 2 covariates plus physical activity measured using a Caltrac vertical accelerometer.
Figure 2
Figure 2
Calf skeletal muscle percentage fat according to ankle brachial index (ABI) in men and women aged 59 and older who wore an activity monitor (n =523). Model 1 adjusts for age, sex, race, comorbidities, body mass index, and smoking history. Model 2 adjusts for Model 1 covariates plus physical activity measured using a pedometer. Model 3 adjusts for Model 2 covariates plus physical activity measured using a Caltrac vertical accelerometer.
Figure 3
Figure 3
Calf skeletal muscle area in legs with higher versus lower ankle brachial index (ABI) values in participants with peripheral arterial disease with significant discrepancies in their left and right leg ankle brachial index values (n =92). *Data are categorized according to the leg with lower ABI. Includes only participants with peripheral arterial disease with no history of lower extremity revascularization.
See this image and copyright information in PMC

References

    1. McDermott MM, Greenland P, Liu K, et al. Leg symptoms commonly reported by men and women with lower extremity peripheral arterial disease: Associated clinical characteristics and functional impairment. JAMA. 2001;286:1599–1606. - PubMed
    1. McDermott MM, Liu K, Greenland P, et al. Functional decline in peripheral arterial disease: Associations with the ankle brachial index and leg symptoms. JAMA. 2004;292:453–461. - PubMed
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