title: Relation Between Erectile Dysfunction and Silent Myocardial Ischemia in Diabetic Patients: A Multidetector Computed Tomographic Coronary Angiographic Study.
abstract: BACKGROUND
  Erectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death.
  
  
  OBJECTIVE
  To evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA).
  
  
  METHODS
  This study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis.
  
  
  METHODS
  Sexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA.
  
  
  RESULTS
  Of 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = -0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04).
  
  
  CONCLUSIONS
  MDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED.
authors.affiliation: Department of Urology, Juntendo University, Tokyo, Japan; Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Abdelhamed
authors.affiliation: Department of Urology, Juntendo University, Tokyo, Japan.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Hisasue
authors.affiliation: Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt.
authors.forename: Essam A
authors.initials: EA
authors.lastname: Nada
authors.affiliation: Department of Internal Medicine, Sohag University, Nasr City, Sohag, Egypt.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Kassem
authors.affiliation: Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abdel-Kareem
authors.affiliation: Department of Urology, Juntendo University, Tokyo, Japan. Electronic address: shorie@juntendo.ac.jp.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horie
keywords: Diabetic Erectile Dysfunction; Multidetector Computed Tomographic Coronary Angiography; Silent Myocardial Ischemia