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Introduction: It has been repeatedly demonstrated that presence of erectile dysfunction (ED) may predate the occurrence of overt event of coronary artery disease. However, the association between severity of ED and left ventricular diastolic dysfunction (LVDD) was rarely reported., Aim: The aim of this study was to assess the association between severity of ED and LVDD in patients without overt cardiac complaint., Main Outcome Measures: The International Index of Erectile Function (IIEF) was used to assess erectile function. Diastolic Doppler parameters measurements and tissue Doppler imaging were used to assess left ventricular diastolic function., Methods: A total of 230 male ED patients without overt cardiac complaint were enrolled in this study. Erectile function was assessed using the IIEF. Patients were also screened for socio demographic data and medical comorbidities that included age, smoking, diabetes, hypertension, and dyslipidemia. All patients were referred to cardiologist for cardiac assessment. Left ventricular diastolic function that included diastolic Doppler parameters measurements and tissue Doppler imaging were also assessed., Results: Mean age±standard deviation was 57.5±5.6 (range of 42-81). There were significant associations between the following risk factors: age, obesity, smoking, hypertension, dyslipidemia, and increased severity of ED (P<0.05 for each). Of the patients, 77.4%, 74.8%, 80%, and 66.1% had abnormal transmitral E/A (E/A) ratio, deceleration time (DT), isovolumic relaxation time (IVRT), mitral E velocity/tissue Doppler imaging E velocity (E/Em) ratio, respectively. Only the means of IVRT and (E/Em) ratio had significant associations with increased severity of ED (P<0.001 for each). There were significant associations between increased severity of ED and the following categorical echo parameters: grades 1 and 2 of E/A ratio, DT, IVRT, and grades 1, 2, and 3 of (E/Em) ratio (P<0.05 for each)., Conclusions: The current study clearly demonstrated that LVDD is prevalent among patients with ED-associated medical comorbidities without overt cardiac complaint. There were significant associations between increased severity of ED and presence of LVDD in those patients., (© 2011 International Society for Sexual Medicine.)

Introduction: Enhanced external counterpulsation (EECP) is a noninvasive outpatient treatment used for patients with intractable angina refractory to aggressive surgical and medical treatment. Recent results have demonstrated a positive impact of EECP on patients with ischemic heart disease (IHD)-associated erectile dysfunction (ED)., Aim: To assess the effect of IHD duration and number of EECP courses on efficacy and satisfaction rate of EECP on patients with IHD-associated ED., Main Outcome Measures: We compared pre- and post-EECP responses to erectile function (EF) domain, Q3 and Q4 of the International Index of Erectile Function score in patients who received one or two courses of EECP and those who had <5- or >or=5-years duration of IHD., Methods: As mentioned in part I a total of 44 male patients with intractable angina caused by coronary insufficiency were enrolled in this study. Treatment course of EECP consists of 35 1-hour sessions over 7 weeks. Another 35 1-hour sessions over another 7 weeks were offered to patients who received one course and required a second course because of no or minimal improvement from class IV to class III angina after the first course., Results: Patients who received only one course (N = 34) had significantly higher EF domain, Q3 and Q4, in pre- and post-EECP results than patients who received two courses (N = 10) after they completed the first course. Patients who had <5-years duration of IHD had significantly higher pre- and post EECP than patients who had >or=5 years regarding EF domain, Q3 and Q4. Considering the global efficacy question, overall satisfaction, and angina, there were significant improvements of post EECP in patients with <5 years than in patients with >or=5-years duration of IHD., Conclusion: The efficacy and satisfaction rate of EECP in patients with IHD-associated ED were negatively influenced by longer duration of IHD and requirement of a second course of EECP.

Purpose: We evaluated the risk factors of coronary artery disease in patients with erectile dysfunction (ED)., Materials and Methods: A total of 417 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. All patients were also screened for sociodemographic data and risk factors for ischemic heart disease (IHD), including age, smoking, diabetes, hypertension, dyslipidemia and psychological disorders. Patients underwent routine laboratory investigation plus testosterone and prolactin assessment. All patients were referred to a cardiologist for IHD evaluation., Results: Mean age +/- SD was 59.1 +/- 10.3 years. Of the patients 27.3% were younger than 50 years, 37.2% were current or former smokers, and 27.6% had mild, 30% had moderate and 42.4% had severe ED. Of the patients 26.9% had different degrees of IHD, of whom 84.8% were older than 50 years. There was a significant association between age and IHD (p <0.05). There were significant associations between IHD, and the increased severity and progressive course of ED (each p <0.05). Furthermore, higher degrees of IHD were significantly associated with severe ED. Diabetes, hypertension, dyslipidemia and psychological disorders were present in 75.1%, 39.3%, 45.6% and 8.2% of the patients, respectively. Overall 92.1% of the patients with ED had 1 or more coronary artery risk factors. The presence of at least 1 risk factor is significantly associated with ED in patients with IHD (p <0.05)., Conclusions: Coronary artery risk factors are significantly associated with erectile dysfunction. A significant association between higher degrees of IHD and the increased severity of ED was detected.