title: Erectile dysfunction in heart failure: correlation with severity, exercise performance, comorbidities, and heart failure treatment.
abstract: BACKGROUND
  Erectile dysfunction (ED) is frequent in males with chronic heart failure (HF) with a severe impact on quality of life for many individuals. The correlation of ED with age and HF severity, comorbidity, and treatment is unclear.
  
  
  OBJECTIVE
  We evaluated the correlation between ED and HF severity, treatment, and comorbidity.
  
  
  METHODS
  One hundred one HF patients aged < or =70 years, with left ventricular ejection fraction < or =40%, and stable clinical condition took part in the study. We measured: (i) hemoglobin, glycemia, glicated hemoglobin, creatinine, cholesterol, thyroid-stimulating-hormone, C-reactive-protein, total/free testosterone; (ii) ED, depression, urological symptoms, and signs of low testosterone by means of questionnaires; and (iii) HF severity by means of echo, brain natriuretic peptide, and cardiopulmonary exercise test.
  
  
  METHODS
  ED was measured by means of International Index of Erectile Function-5 questionnaire and its score was correlated with exercise cardiopulmonary test parameters, HF severity, treatment and HF comorbidities.
  
  
  RESULTS
  ED prevalence was 69.3%, 81.1%, and 56% in total population and in patients with and without coronary artery lesions, respectively. ED was absent in 31 while it scored mild, mild to moderate, moderate and severe in 15, 18, 12, 25 individuals, respectively. Sexual activity requires, in the orgasmic phase, an oxygen consumption (VO(2)) between 10 and 14 mL/min/kg. In none of the individuals with peak VO(2) < 10 mL/min/kg was sexual function normal or slightly impaired, while in 10/29 of patients with peak VO(2) between 10 and 14 mL/min/kg there was a normal or slightly reduced sexual performance. On monovariable analysis, several parameters were correlated with ED, but at multivariable analysis only age (P = 0.002), hemoglobin (P = 0.042), diabetes (P = 0.040), and use of diuretics (P = 0.052) remained so.
  
  
  CONCLUSIONS
  ED is frequent in HF. A normal or only slightly impaired sexual activity is possible with peak VO(2) > 10 mL/min/kg. On multivariable analysis, only age, diabetes, use of diuretics, and hemoglobin are related to ED.
authors.affiliation: Istituto di Scienze Cardiovascolari, Università di Milano-Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Apostolo
authors.forename: Carlo
authors.initials: C
authors.lastname: Vignati
authors.forename: Denise
authors.initials: D
authors.lastname: Brusoni
authors.forename: Gaia
authors.initials: G
authors.lastname: Cattadori
authors.forename: Mauro
authors.initials: M
authors.lastname: Contini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Damiano
authors.initials: D
authors.lastname: Magrì
authors.forename: Pietro
authors.initials: P
authors.lastname: Palermo
authors.forename: Calogero
authors.initials: C
authors.lastname: Tedesco
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Doria
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
mesh_terms: D000367:Age Factors; D015331:Cohort Studies; D015897:Comorbidity; D015444:Exercise; D017079:Exercise Tolerance; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D018783:Impotence, Vasculogenic / Q000453:epidemiology / Q000209:etiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010101:Oxygen Consumption; D015995:Prevalence; D011594:Psychometrics; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D011795:Surveys and Questionnaires