Abdelhamed Amr, Hisasue Shin-Ichi, Nada Essam A, Kassem Ali M, Abdel-Kareem Mohammed, Horie Shigeo
Department of Urology, Juntendo University, Tokyo, Japan; Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt.
Department of Urology, Juntendo University, Tokyo, Japan.
Sex Med. 2016 Sep;4(3):e127-34. doi: 10.1016/j.esxm.2016.04.005. Epub 2016 Jun 30.
Erectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death.
To evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA).
This study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis.
Sexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA.
Of 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = -0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04).
MDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED.
勃起功能障碍（ED）可能先于冠状动脉疾病出现。此外，无症状性心肌缺血（SMI）在糖尿病患者中更为常见，并且是心脏事件和死亡的有力预测指标。
使用多排螺旋计算机断层扫描冠状动脉造影（MDCT-CA）评估糖尿病合并ED患者中SMI的存在情况。
本研究评估了无任何心脏症状或体征病史的糖尿病合并ED患者。通过男性性健康量表评分、勃起硬度评分（EHS）以及使用勃起测量仪测量阴茎最大周径变化来评估勃起功能。MDCT-CA用于检测冠状动脉狭窄。
男性性健康量表评分、EHS、阴茎最大周径变化以及MDCT-CA检测的冠状动脉狭窄情况。
20例患者（平均年龄=61.45±10.7岁）中，MDCT-CA显示13例（65%）存在冠状动脉狭窄，其形式为单支血管病变（n=6，30%）、双支血管病变（n=2，10%）和三支血管病变（n=5，25%）。50%的患者左前降支冠状动脉至少有50%的血管腔阻塞，这是最常受累的血管（55%）。15%（20例中的3例）的患者狭窄程度大于90%，其中2例立即接受了冠状动脉血管成形术并置入支架以预防心肌梗死。冠状动脉最大狭窄程度与年龄呈正相关（P=0.016，r=0.529），与EHS呈负相关（P=0.046，r=-0.449）。使用年龄和EHS进行的多变量回归分析表明，年龄是SMI的唯一独立预测因素（P=0.04）。
MDCT-CA可作为识别糖尿病合并ED患者中SMI的有用工具，尤其是在老年和/或重度ED患者中。
