title: Poor response to alprostadil ICI test is associated with arteriogenic erectile dysfunction and higher risk of major adverse cardiovascular events.
abstract: BACKGROUND
  Intracavernous alprostadil injection (ICI) test has been considered useless in assessing the vascular status of subjects with erectile dysfunction (ED).
  
  
  OBJECTIVE
  To analyze the clinical correlates of ICI test in patients with ED and to verify the value of this test in predicting major adverse cardiovascular events (MACE).
  
  
  METHODS
  A consecutive series of 2,396 men (mean age 55.9 ± 11.9 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of this sample (N = 1,687) was enrolled in a longitudinal study.
  
  
  METHODS
  Several clinical, biochemical, and instrumental (penile color Doppler ultrasound; PCDU) factors were evaluated. All patients underwent an ICI test, and responses were recorded on a four-point scale ranging from 1 = no response to 4 = full erection.
  
  
  RESULTS
  Among the patients studied, 16.4%, 41.2%, 40.2% and 2.2% showed grade 4, 3, 2, and 1 ICI test response, respectively. After adjusting for confounders, subjects with grade 1 ICI test response showed reduced perceived sleep-related, masturbation-related, and sexual-related erections when compared with the rest of the sample. In addition, a worse response to ICI test was associated with a higher prevalence of hypogonadism-related symptoms and signs along with lower testosterone levels. The prevalence of both diabetes mellitus and metabolic syndrome was inversely related to ICI test response. Accordingly, dynamic and basal peak systolic velocity (PSV), as well as acceleration at PCDU, decreased as a function of ICI test response. In the longitudinal study, after adjusting for confounders, grade 1 response was independently associated with a higher incidence of MACE (hazard ratio = 2.745 [1.200-6.277]; P < 0.05). These data were confirmed even when only subjects with normal PSV (>25 cm/s) were considered.
  
  
  CONCLUSIONS
  Our results demonstrate that poor ICI test response is associated with several metabolic disturbances and higher incidence of MACE. We strongly recommend performing ICI test with alprostadil in all ED subjects.
authors: Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
authors: Giulia
authors: G
authors: Rastrelli
authors: Giovanni
authors: G
authors: Corona
authors: Matteo
authors: M
authors: Monami
authors: Cecilia
authors: C
authors: Melani
authors: Daniela
authors: D
authors: Balzi
authors: Alessandra
authors: A
authors: Sforza
authors: Gianni
authors: G
authors: Forti
authors: Edoardo
authors: E
authors: Mannucci
authors: Mario
authors: M
authors: Maggi
mesh_terms: D000527:Alprostadil / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D054526:Men's Health; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D017211:Treatment Failure; D018608:Ultrasonography, Doppler; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D000527:Alprostadil