男性无传统危险因素时阴茎松弛加速度作为心血管风险标志物。

Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors.

机构信息

Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.

出版信息

J Sex Med. 2014 Jan;11(1):173-86. doi: 10.1111/jsm.12342. Epub 2013 Oct 23.

DOI:10.1111/jsm.12342

PMID:24433560

Abstract

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.

摘要

简介

传统心血管（CV）危险因素只能识别一半发生重大不良 CV 事件（MACE）的患者。因此，需要在高 CV 风险患者中寻找新的标志物，如勃起功能障碍（ED）患者。阴茎彩色多普勒超声（PCDU）中的动态收缩期峰值速度（D-PSV）可能具有作用，但它依赖于操作者，并且耗时。阴茎松弛加速度（FPA）是 PCDU 参数，它反映了 PSV、收缩上升时间（SRT）和舒张末期速度（EDV），通过算术定义为（PSV-EDV）/SRT。

目的

本研究旨在在大量 ED 患者中验证 FPA 在预测 MACE 中的作用。

方法

回顾性研究了 2000 年 1 月至 2012 年 7 月间因疑似 ED 存在器质性因素而就诊的 1903 例患者（年龄 54.6±11.7）。该样本的一部分（n=622）被纳入一项纵向研究，该研究于 2007 年 12 月结束。

主要观察指标

研究了多种临床、生化和仪器（PCDU）参数。

结果

FPA 水平降低与较差的代谢谱和性功能症状相关。此外，FPA 与总睾酮和计算的游离睾酮均呈正相关。在纵向研究中，未经调整的 MACE 发生率与较低的基线 FPA 显著相关。当 FPA 与 D-PSV 一起引入多变量模型，经年龄和慢性疾病评分校正后，较低的 FPA（而非 D-PSV）与较低风险（即年轻（HR=0.48[0.23-0.99]）、非高血压（HR=0.59[0.38-0.92]）、非肥胖（HR=0.68[0.49-0.96]）或非糖尿病（HR=0.67[0.49-0.96]）患者的 MACE 事件相关，所有 P 值均<0.05，但在高风险患者中则无此相关性。FPA 在预测 MACE 时存在一个阈值效应，其值<1.17m/s（2）时，MACE 发生率增加三倍，这表明在看似较低风险的个体中，MACE 发生率增加。