Related Experiment Video
Updated: May 3, 2026
Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors
Giulia Rastrelli1, Giovanni Corona, Francesco Lotti
1Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Insights
Flaccid penile acceleration (FPA) can predict major adverse cardiovascular events (MACE) in men with erectile dysfunction (ED). Lower FPA levels indicate higher CV risk, especially in lower-risk individuals.
Area of Science:
- Cardiology
- Urology
- Vascular Ultrasound
Background:
- Conventional cardiovascular (CV) risk factors identify only half of individuals experiencing major adverse CV events (MACE).
- Erectile dysfunction (ED) is prevalent in high CV risk populations, necessitating novel predictive markers.
- Dynamic peak systolic velocity (D-PSV) via penile color Doppler ultrasound (PCDU) has shown potential but is operator-dependent and time-consuming.
Purpose of the Study:
- To evaluate the predictive capability of Flaccid penile acceleration (FPA), a novel PCDU parameter, for MACE in a large cohort of ED patients.
- To determine if FPA can identify individuals at increased risk for adverse cardiovascular outcomes.
Main Methods:
- A retrospective study of 1,903 male patients with suspected organic ED from January 2000 to July 2012.
- A subset of 622 patients was enrolled in a longitudinal study concluding in December 2007.
- Analysis included clinical, biochemical, and PCDU parameters, focusing on FPA and D-PSV.
Main Results:
- Lower FPA levels correlated with poorer metabolic profiles and more severe sexual symptoms.
- In a longitudinal analysis, lower baseline FPA was significantly associated with MACE incidence.
- Multivariate analysis revealed that lower FPA, but not D-PSV, predicted MACE in younger, nonhypertensive, nonobese, or nondiabetic individuals.
- A threshold FPA value <1.17 m/s² indicated a threefold increase in MACE risk in apparently lower-risk individuals.
Conclusions:
- Flaccid penile acceleration (FPA) is an easily acquired PCDU parameter.
- FPA effectively identifies adverse metabolic and cardiovascular risk profiles in patients with ED.
- FPA is particularly valuable for risk stratification in apparently lower-risk individuals with ED.
Introduction:
Conventional cardiovascular (CV) risk factors identify only half of subjects with incident major adverse CV events (MACE). Hence new markers are needed in high CV risk subjects, as those with erectile dysfunction (ED). A role for dynamic peak systolic velocity (D-PSV) at penile color Doppler ultrasound (PCDU) has been suggested, but it is operator dependent and time consuming. Flaccid penile acceleration (FPA) is a PCDU parameter that reflects PSV, the systolic rise time (SRT), and end diastolic velocity (EDV), arithmetically defined as (PSV-EDV)/SRT.
Aim:
The study aims to verify, in a large series of ED patients, whether FPA has a role in predicting MACE.
Methods:
A selected series of 1,903 patients (aged 54.6 ± 11.7) with a suspected organic component for ED was retrospectively studied from January 2000 until July 2012. A subset of this sample (n = 622) was enrolled in a longitudinal study that ended in December 2007.
Main Outcome Measures:
Several clinical, biochemical, and instrumental (PCDU) parameters were studied.
Results:
Decreased FPA levels were associated with worse metabolic profile and sexual symptoms. In addition, FPA was positively associated with both total and calculated free testosterone. In the longitudinal study, unadjusted incidence of MACE was significantly associated with lower baseline FPA. When FPA was introduced in a multivariate model, along with D-PSV, after adjusting for age and Chronic Disease Score, lower FPA, but not D-PSV, was associated with incident MACE in lower--risk-i.e., younger (HR = 0.48 [0.23-0.99]), nonhypertensive (HR = 0.59 [0.38-0.92]), nonobese (HR = 0.68 [0.49-0.96]), or nondiabetic (HR = 0.67 [0.49-0.96] subjects; all P < 0.05--but not in higher-risk ones. FPA demonstrated a threshold effect in predicting MACE at a value <1.17 m/s(2) which showed a threefold increase in incidence of MACE in apparently lower-risk individuals.
Conclusions:
FPA is an easily obtained PCDU parameter and capable of identifying adverse metabolic and CV profiles, particularly in apparently lower-risk individuals with ED.
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:20Disorders of the Male Reproductive System
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
01:17Male Sexual Response: Erection & Ejaculation
The blood filling the erectile tissues compresses the veins, which helps to prevent blood from leaving...
01:16Pulse
The pulse serves as a clinical...
01:29Cardiovascular System Abnormal Findings I: Inspection and Palpation
Abnormal findings observed during an inspection
01:17Measurement of Blood Pressure