Screening of ischemic heart disease with cavernous artery blood flow in erectile dysfunctional patients

Abstract

Erection is a hemodynamic event and accordingly, erectile dysfunction (ED) is closely related with ischemic heart disease. We should con®rm that the cardiac condition of the ED patient is safe enough to perform sexual intercourse prior to beginning treatment for ED. Asymptomatic ischemic heart disease cannot be diagnosed only in an interview, but it's dif®cult to perform cardiac exercise tests on all patients complaining of ED. Therefore, screening methods to evaluate patients who should undergo exercise tests are needed. Sixty patients with erectile dysfunction participated in this study. Physical examinations, interviews, and color Doppler examinations were conducted. Chest X-rays and electrocardiograms of all patients in the resting position were obtained, as were electrocardiograms following exercise. Echocardiograms, treadmill test results, thallium exercise scintigrams, and coronary angiograms were obtained as required for diagnosis. Two patients were excluded because they had obvious arteriogenic ED due to perineal injury. Fifty-eight patients underwent Doppler evaluations of their cavernous arteries and heart exercise tests. Fourteen patients (24.1%) were diagnosed with ischemic heart disease. Although six of them had already been diagnosed with ischemic heart disease, eight were newly diagnosed by the exercise tests. Cardiovascular risk factors such as advanced age, hyperlipidemia, diabetes mellitus, hypertension, smoking, and obesity were not suf®cient predictive factors. The mean peak systolic velocity of the patients without ischemic heart disease was 34.6 cmas vs 22.0 cmas in those with ischemic heart disease. Only 3.7% of patients whose peak systolic velocity in the cavernous artery was equal to or exceeded 35 cmas had ischemic heart disease. On the other hand, 41.9% of patients with peak systolic velocity of less than 35 cmas had ischemic heart disease. The sensitivity of peak systolic velocity against ischemic heart disease was 92.9%, and speci®city was 59.1%. In ED patients, incidences of complications involving symptomatic or asymptomatic ischemic heart disease were found to be high. The peak systolic velocity in the cavernous artery is thought to be a useful predictive factor of ischemic heart disease in ED patients. When a patient reveals a peak systolic velocity of less than 35 cmas, he should undergo heart exercise tests prior to treatment of ED.

Relation of C-reactive protein and other cardiovascular risk factors to penile vascular disease in men with erectile dysfunction

“…Another study confirmed our results by showing penile Doppler score to be a more reliable test for the presence of ischemic heart disease than many traditional cardiovascular risk factors. 6 In that study, the mean PSV of the patients without ischemic heart disease was 34.6 vs 22.0 cm/s in those with ischemic heart disease. The sensitivity of PSV against ischemic heart disease was 92.9% and specificity was 59.1%.…”

“…Other investigators have reported a higher incidence of abnormal penile blood flow when the patient history includes risk factors such as previous MI, hypertension, or cigarette smoking. 2,4,5 Kawanishi et al 6 showed that men with ED and an abnormal penile Doppler ultrasound exam are at increased risk for ischemic heart disease. 6 To date, there have been few studies assessing the relation between the severity of penile vascular disease and traditional CVD risk factors.…”

“…2,4,5 Kawanishi et al 6 showed that men with ED and an abnormal penile Doppler ultrasound exam are at increased risk for ischemic heart disease. 6 To date, there have been few studies assessing the relation between the severity of penile vascular disease and traditional CVD risk factors. Furthermore, little data exist concerning the relation between emerging markers for CVD risk (C-reactive protein (CRP), Lp(a), homocysteine) and penile vascular disease severity.…”

Correlation between penile duplex findings and stress electrocardiography in men with erectile dysfunction

“…Patients with low PSV values were more susceptible to IHD than those with normal values. In the study conducted by Kawanishi et al (2001), 1 patients with a PSV value of less than 35 cm/s had a 41.9% incidence of IHD. Our results confirm these findings.…”

“…1 Several risk factors are shared by ED and atherosclerotic vascular disease (eg IHD); among these are smoking, hyperlipidemias, hypertension and diabetes mellitus. This observation underlies a common vascular pathology.…”