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Screening of ischemic heart disease with cavernous artery blood flow in erectile dysfunctional patients
Y Kawanishi1, K S Lee, K Kimura
1Department of Urology, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan. kawani@mail2.netwave.or.jp
Insights
Erectile dysfunction (ED) patients often have undiagnosed ischemic heart disease. Peak systolic velocity in the cavernous artery can predict heart issues, guiding the need for cardiac exercise tests before ED treatment.
Area of Science:
- Cardiology
- Urology
- Vascular Medicine
Background:
- Erectile dysfunction (ED) is linked to ischemic heart disease (IHD) due to shared hemodynamic factors.
- Screening for IHD in ED patients is crucial before initiating ED treatment.
- Current screening methods like interviews and exercise tests have limitations for all ED patients.
Purpose of the Study:
- To evaluate the utility of peak systolic velocity (PSV) in the cavernous artery as a predictor of IHD in ED patients.
- To identify ED patients who require further cardiac evaluation, specifically exercise testing.
Main Methods:
- Fifty-eight ED patients underwent physical examinations, Doppler evaluations of cavernous arteries, and cardiac exercise tests.
- Diagnostic tools included electrocardiograms, echocardiograms, treadmill tests, and coronary angiograms as needed.
- PSV measurements were correlated with IHD diagnosis.
Main Results:
- Fourteen patients (24.1%) were diagnosed with IHD, with eight new diagnoses.
- Cardiovascular risk factors were insufficient predictors of IHD.
- A PSV < 35 cm/s was associated with a 41.9% IHD prevalence, while PSV ≥ 35 cm/s had only 3.7% IHD.
- PSV demonstrated 92.9% sensitivity and 59.1% specificity for IHD detection.
Conclusions:
- A significant number of ED patients have undiagnosed IHD.
- Cavernous artery PSV is a valuable, non-invasive screening tool for IHD in ED patients.
- ED patients with PSV < 35 cm/s warrant cardiac exercise testing prior to ED treatment.
Abstract:
Erection is a hemodynamic event and accordingly, erectile dysfunction (ED) is closely related with ischemic heart disease. We should confirm 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 difficult 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 sufficient predictive factors. The mean peak systolic velocity of the patients without ischemic heart disease was 34.6 cm/s vs 22.0 cm/s 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 cm/s had ischemic heart disease. On the other hand, 41.9% of patients with peak systolic velocity of less than 35 cm/s had ischemic heart disease. The sensitivity of peak systolic velocity against ischemic heart disease was 92.9%, and specificity 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 cm/s, he should undergo heart exercise tests prior to treatment of ED.