Comparison of Findings on Stress Myocardial Perfusion Imaging in Men With Versus Without Erectile Dysfunction and Without Prior Heart Disease

Abstract

Erectile dysfunction (ED) has been associated with a future risk of myocardial infarction, yet the findings on stress testing in men with ED and without previous coronary artery disease are unknown. Stress myocardial perfusion single-photon emission computed tomographic imaging (MPI) allows detection of coronary artery disease and predicts cardiovascular prognosis. Our goal was to determine the association between ED and findings at stress MPI testing in men without previous coronary artery disease. Five hundred seventy-five men without previous coronary artery disease referred for stress MPI were prospectively screened for ED with the validated International Index of Erectile Function. ED was present in 46% of subjects, and ED was associated with more mild (summed stress score >or=4) and severe (summed stress score >8) coronary artery disease and with more composite high-risk stress MPI findings (summed stress score >8, left ventricular ejection fraction <40%, transient ischemic dilation). In patients referred for exercise, ED was associated with a lower Duke treadmill score. On multivariate analysis, ED was found to be an independent predictor of a summed stress score >or=4, a summed stress score >8, and composite high-risk MPI findings. In conclusion, in men without known coronary artery disease referred for stress MPI testing, ED is associated with adverse prognostic indicators at MPI testing including coronary artery disease and high-risk MPI findings.