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Transitory myocardial ischemia in patients with vascular lower limb amputation: relationship with long-term

Sheila Jean McNeill Ingham1, Therezinha Rosane Chamlian, José Marconi de Souza

  • 1Department of Physical Medicine and Rehabilitation, Federal University of São Paulo, São Paulo, SP, Brazil.

American Journal of Physical Medicine & Rehabilitation
|January 27, 2009
PubMed

Insights

Nearly half of vascular lower limb amputees show signs of silent myocardial ischemia. This condition is linked to a higher risk of serious cardiovascular events and death during follow-up.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Nuclear Medicine

Background:

  • Vascular lower limb amputees often have underlying coronary artery disease.
  • Asymptomatic patients may have undiagnosed myocardial ischemia.
  • Assessing ischemia risk is crucial for long-term patient outcomes.

Purpose of the Study:

  • To determine the prevalence of asymptomatic myocardial ischemia in vascular amputees.
  • To investigate the association between ischemia and future atherothrombotic events.

Main Methods:

  • A cohort study of 58 lower limb vascular amputees was conducted.
  • Patients underwent dipyridamole myocardial scintigraphy.
  • Cardiovascular events were tracked over a mean 2.1-year follow-up.

Main Results:

  • 44.8% of patients exhibited positive scintigraphy for myocardial ischemia.
  • 20.7% experienced severe cardiovascular events, predominantly in those with positive ischemia tests (P < 0.025).
  • Higher mortality was observed in patients with positive scintigraphy, though not statistically significant (P = 0.09).

Conclusions:

  • A significant portion of vascular amputees have asymptomatic myocardial ischemia.
  • Positive scintigraphy indicates an increased risk of atherothrombotic events and mortality.
  • Myocardial scintigraphy is valuable for risk stratification in this patient group.
Abstract

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