Erectile dysfunction severity as a predictor of left main and/or three-vessel disease in acute coronary syndrome patients

Early predictors of severe left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction: A dual-center retrospective study

BACKGROUND

Early detection of patients concomitant with left main and/or three-vessel disease (LM/3VD) and high SYNTAX score (SS) is crucial for determining the most effective revascularization options regarding the use of antiplatelet medications and prognosis risk stratification. However, there is a lack of study for predictors of LM/3VD with SS in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to identify potential factors that could predict LM/3VD with high SS (SS > 22) in patients with NSTEMI.

METHODS

This dual-center retrospective study included a total of 481 patients diagnosed with NSTEMI who performed coronary angiography procedures. Clinical factors on admission were collected. The patients were divided into non-LM/3VD, Nonsevere LM/3VD (SS ≤ 22), and Severe LM/3VD (SS > 22) groups. To identify independent predictors, Univariate and logistic regression analyses were conducted on the clinical parameters.

RESULTS

A total of 481 patients were included, with an average age of 60.9 years and 75.9% being male. Among these patients, 108 individuals had severe LM/3VD. Based on the findings of a multivariate logistic regression analysis, the extent of ST-segment elevation observed in lead aVR (OR: 7.431, 95% CI: 3.862-14.301, p < .001) and age (OR: 1.050, 95% CI: 1.029-1.071, p < .001) were identified as independent predictors of severe LM/3VD.

CONCLUSION

This study indicated that the age of patients and the extent of ST-segment elevation observed in lead aVR on initial electrocardiogram were the independent predictive factors of LM/3VD with high SS in patients with NSTEMI.

[Prevalence and characteristics of erectile dysfunction in coronary patients in Abidjan Heart Institute of Côte d'ivoire]

INTRODUCTION

Erectile dysfunction (ED) represents an independent and/or predictive risk factor for coronary heart disease according to many studies. The aim of our study is to determine the prevalence and risk factors associated with erectile dysfunction in coronary patients confirmed by coronary angiography.

MATERIAL AND METHOD

We conducted a descriptive and analytical cross-sectional study. A total of 60 patients were included with proven atheromatous coronary lesions after coronary angiography. The study period was from June 1, 2020 to February 29, 2021. After assessment of erectile status based on the short version of the International Index of Erectile Function (IIEF-5). Measures of association were adjusted odds ratios and odd ratios with their confidence intervals. Multivariate analysis was conducted using logistic regression. Only patients with erectile insufficiency underwent penile pharmocodoppler.

RESULTS

The mean age was 56 ± 8.4 years with extremes of 28 and 65 years. Erectile status was classified according to the IIEF-5 score as follows: severe ED (32%), moderate (13%), mild (15%) and normal erectile function (40%). The time to onset of ED was> 2 years in 69.4% of cases before the onset of coronary artery disease with a mean time of 2.37 years ± 1.29. In 20% of the cases, the patients were already on treatment before the erectile disorder, 65% undergoing treatment after the erectile disorder and 15% had no undergoing treatment. The main factors associated with ED were: high blood pressure (OR = 7; p = 0.0007), dyslipidemia (OR = 4.86; p = 0.004), diabetes (OR = 3.8; p = 0.02), obesity (OR = 4, 45; p = 0.02) as well as beta blockers (OR = 5.3; p = 0.004), calcium channel blockers (OR = 4.5; p = 0.004) and angiotensin-converting enzyme inhibitors (OR = 4.3; p = 0.008). The vascular cause clearly dominates (95%) of which 61% arterial mechanism, 17% mixed and 17% venous mechanism. The factor associated with a decrease PSVpi was the diabetes (OR = 28; p = 0.01). In multivariate analysis, no factor was statistically associated with ED or decrease in PSVpi.

CONCLUSION

Isolated ED appears as an early marker of generalized endothelial dysfunction. Hence the advantage of systematic screening, especially in subjects at risk of cardiovascular disease.

Angiotensin-(1-7) improves diabetes mellitus-induced erectile dysfunction in rats by regulating nitric oxide synthase levels

This study explores the role of inducible nitric oxide synthase (iNOS) in the pathogenesis of diabetes mellitus-induced erectile dysfunction (DMED) and the effect of angiotensin 1-7 (Ang- [1-7]) on NOS levels. A type 2 diabetes mellitus (DM) rat model was established. Erectile function was assessed by measuring intracavernous pressure and mean arterial pressure after electrical stimulation. The expression of iNOS, endothelial NOS (eNOS), eNOS phosphorylated at Ser 1177 (p-eNOS [Ser 1177]), and AKT/p-AKT in corpus cavernosum smooth muscle cells (CCSMCs) was measured by Western blotting and immunofluorescence. The plasma levels of NO, SOD, malondialdehyde, and peroxynitrite were calculated. Intracellular calcium content was determined by flow cytometry. DMED rats exhibited decreased erectile function and severe oxidative stress. Ang-(1-7) treatment improved erectile response and suppressed oxidative stress by upregulating p-eNOS/eNOS and downregulating iNOS levels. Silencing iNOS in CCSMCs decreased oxidative stress and intracellular calcium levels induced by high glucose. In turn, iNOS overexpression increased oxidative stress and intracellular calcium level. Treatment with the MAS receptor antagonist A779 and the Akt antagonist LY294002 reversed the effects of Ang-(1-7) on iNOS. Ang-(1-7) improved DMED through the MAS/AKT signaling pathway.

The Relationship Between Gensini Score and Erectile Dysfunction in Patients with Chronic Coronary Syndrome

Introduction

In previous studies, the relationship between atherosclerosis and erectile dysfunction (ED) was examined, but the relationship and correlation between Gensini score which evaluates the extent and severity of chronic coronary syndrome (CCS), and ED severity were not investigated.

Aim

To evaluate the relationship between Gensini score and ED in patients with CCS.

Methods

We included 142 consecutive male patients with the diagnosed CCS and underwent an elective coronary angiography between January 2019 and March 2020.

Main Outcome Measure

Correlation analysis demonstrated that Gensini score significantly negatively correlated with the International Index Erectile Function - 5 (IIEF-5) score (r = -0.417, P < .001).

Results

Severe ED was present in 48 (33.8%) patients, moderate ED in 31 (21.8%) patients, and mild ED in 22 (15.5%) patients. 41(28.9%) patients did not have ED. Both the No ED and Mild ED groups were statistically significantly lower than the Severe ED group in terms of the Gensini score (P < .05). When the recommended optimal cut-off point and accuracy measurements were made for the Gensini score, the area under curve (AUC) value in predicting ED was 0.806 (95% CI: 0.732-0.880, P < .001). Multivariate logistic regression analysis demonstrated that independent predictors for ED were Gensini score and age (P < .001, and P = .026, respectively). Every 1 unit increase in Gensini score resulted in a 6% increase in the occurrence of ED (OR = 1.06, CI:1.03-1.10, P < .001).

Conclusion

ED can be caused by endothelial dysfunction. Patients with severe CSS and high Gensini score should be evaluted for ED. ED may be a sign of severe CCS and a high Gensini score. It is also necessary to evaluate cardiological in patients with ED.

Deger M, Ozmen C, Akdogan N, et al. The Relationship Between Gensini Score and Erectile Dysfunction in Patients with Chronic Coronary Syndrome. Sex Med 2021;9:100376.

Detection of Coronary Artery Disease by an Erectile Dysfunction Questionnaire

Background

Erectile dysfunction (ED) has been become an important health challenge in recent years affecting the quality of life significantly. In addition to imposed social problems, it may warn the existence of cardiovascular diseases especially that of ischemic heart disease (IHD). We aimed to investigate the association between ED and coronary artery disease (CAD) in a population of patients with stable angina based on angiographic findings.

Methods

In this cross-sectional study, among patients who are diagnosed with stable angina referring for coronary angiography (excluding those with acute coronary syndrome), 200 patients were selected. They were divided equally into two groups of case and control. The former were positively CAD patients and the latter were normal peers, with respect to angiographic results. International index of erectile function (IIEF) questionnaire was used in order to evaluate erectile function during recent four weeks. Statistical analyses of the t-test and logistic regression were performed. The significance level was considered as a P value less than 5%.

Results

The age range of the patients was 40–65 years old. The case group was significantly older (P=0.001). There was a remarkable relation between the low score from IIEF (ED) and existence of CAD. Also, the severity of ED was in a close relationship with severity of CAD. In addition, dyslipidemia in terms of high LDL and low HDL was associated with both ED and severity of CAD.

Conclusion

Other than CAD, ED could be considered as one of the manifestations of atherosclerosis. Accordingly, the IIEF questionnaire is a useful tool to early diagnosis of CAD. Also, IIEF-derived scores estimate CAD severity. We suggest subjects with low score of IIEF examine their cardiovascular health with special attention to possible existence of IHD.