title: Erectile dysfunction, endothelium dysfunction, and microvascular damage in patients with systemic sclerosis.
abstract: BACKGROUND
  Erectile dysfunction (ED) prevalence in men with systemic sclerosis (SSc) is high and can be considered a manifestation of endothelium damage.
  
  
  OBJECTIVE
  This study aims to correlate ED with endothelial dysfunction and digital vascular damage in SSc patients.
  
  
  METHODS
  The main outcome measures were erectile function, Doppler indices of cavernous arteries, flow-mediated dilation (FMD), capillaroscopic damage, skin perfusion, and digital pulsatility.
  
  
  METHODS
  In 23 SSc patients, erectile function was investigated using the International Index of Erectile Function-5 (IIEF-5). Doppler indices of cavernous arteries, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured at the penoscrotal junction before and after pharmacostimulation with 20 mg prostaglandin E1. FMD and nailfold videocapillaroscopy (NVC) were used to evaluate endothelial dysfunction and capillaroscopic damage. Skin perfusion and digital sphygmic waves were measured by laser Doppler perfusion imaging (LDPI) and digital photoplethysmography (PPG), respectively.
  
  
  RESULTS
  IIEF-5 score was reduced in 83% of patients. PSV was reduced in 96%, while EDV was increased in 48% of patients. A positive correlation was observed between IIEF-5 score and FMD (r = 0.71, P < 0.0001) and between the former and PSV (r = 0.76, P < 0.0001). A negative correlation was observed between EDV and FMD (r = -0.509, P < 0.01). FMD and Doppler indices were reduced with capillaroscopic damage progression. A positive correlation exists between LDPI perfusion and IIEF-5 score (r = 0.743, P < 0.0001) and between the former and PSV (r = 0.714, P < 0.0001), while a negative correlation is observed between LDPI perfusion and EDV (r = -0.677, P < 0.0001). A positive correlation exists between PPG pulsatility and IIEF-5 score (r = 0.752, P < 0.0001) and between the former and PSV (r = 0.747, P < 0.0001), while negative correlation is observed between PPG pulsatility and EDV (r = -0.689, P < 0.0001).
  
  
  CONCLUSIONS
  In SSc patients, ED correlates with endothelial dysfunction and digital microvascular damage.
authors: Department of Clinical Medicine, Clinical Immunology Unit-Scleroderma Center, Sapienza University of Rome, Rome, Italy.
authors: Edoardo
authors: E
authors: Rosato
authors: Biagio
authors: B
authors: Barbano
authors: Antonietta
authors: A
authors: Gigante
authors: Antonio
authors: A
authors: Aversa
authors: Rosario
authors: R
authors: Cianci
authors: Ilenia
authors: I
authors: Molinaro
authors: Silvia
authors: S
authors: Quarta
authors: Simonetta
authors: S
authors: Pisarri
authors: Antonella
authors: A
authors: Afeltra
authors: Felice
authors: F
authors: Salsano
mesh_terms: D000328:Adult; D000368:Aged; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography; D012595:Scleroderma, Systemic / Q000150:complications*; D018608:Ultrasonography, Doppler