Kilic Metin, Caglayan Volkan, Sambel Murat, Erdogan Abdullah, Onen Efe, Kurtoglu Unal, Erkan Anıl, Avci Sinan, Ekici Ozgur
Department of Urology, Bursa Yuksek Ihtisas Training and Research Hospital, Yildirim 16310, Bursa, Turkey.
Department of Urology, Bursa City Hospital, Nilufer 16110, Bursa, Turkey.
Sex Med. 2023 Jul 31;11(3):qfad042. doi: 10.1093/sexmed/qfad042. eCollection 2023 Jun.
Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature.
We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I).
A total of 274 subjects were divided into two groups: ED patients ( = 150) and controls ( = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders.
Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED.
Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group ( .021, = .006, and < .001, respectively). The IIEF-5 score was significantly lower in the ED group ( < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders ( = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders ( = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) ( = .001), and the cutoff value was determined to be 0.825 mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity.
Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon.
There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist.
CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.
颈动脉内膜中层厚度（CIMT）增加已被证明与勃起功能障碍（ED）相关，但文献中缺乏评估CIMT预测药物反应疗效的研究。
我们旨在评估CIMT预测磷酸二酯酶-5抑制剂（PDE5-I）反应的疗效。
总共274名受试者被分为两组：ED患者（n = 150）和对照组（n = 124）。ED组患者进一步分为重度、中度、轻中度和轻度ED亚组。对所有受试者进行血液检查、颈动脉超声检查和国际勃起功能指数-5（IIEF-5）诊断工具评估。给每位患者服用他达拉非。治疗2个月后使用IIEF-5问卷对患者进行重新评估。根据他们对药物的反应，将患者评估为反应者或无反应者。
CIMT增加与PDE5-I治疗失败显著相关，尤其是在中度/轻中度ED患者中。
与对照组相比，ED组的空腹血糖、体重指数和CIMT显著更高（分别为P = 0.021、P = 0.006和P < 0.001）。ED组的IIEF-5评分显著更低（P < 0.001）。CIMT与IIEF-5评分显著相关。当评估整个患者组时，反应者的CIMT值显著低于无反应者（P = 0.001）。与反应者相比，中度/轻中度ED的无反应者中的CIMT显著更高（分别为P = 0.004和P = 0.008），而重度或轻度ED的反应者和无反应者之间的CIMT没有显著差异。对中度/轻中度ED的无反应者和反应者之间的CIMT进行受试者操作特征（ROC）分析。ROC曲线下面积为0.801（0.682 - 0.921）（P = 0.001），截止值确定为0.825 mm，此时CIMT预测治疗反应的敏感性为65%，特异性为89%。
使用经过验证的CIMT截止值可以帮助医生告知患者药物治疗失败的可能性，并避免过早尝试二线治疗。
我们的研究有三个主要局限性。第一，参与者数量较少。第二，超声是一种相对主观的方法，第三，所有测量均由同一位放射科医生进行。
CIMT可作为中度/轻中度ED患者对PDE5-I治疗反应的预测指标。
