title: History of erectile dysfunction as a predictor of poor physical performance after an acute myocardial infarction.
abstract: Background Erectile dysfunction may predict future cardiovascular events and indicate the severity of coronary artery disease in middle-aged men. The aim of this study was to evaluate whether erectile dysfunction (expression of generalized macro- and micro-vascular pathology) could predict reduced effort tolerance in patients after an acute myocardial infarction. Patients and methods One hundred and thirty-nine male patients (60 ± 12 years old), admitted to intensive cardiac rehabilitation 13 days after a complicated acute myocardial infarction, were evaluated for history of erectile dysfunction using the International Index of Erectile Function questionnaire. Their physical performance was assessed by means of two six-minute walk tests (performed two weeks apart) and by a symptom limited cardiopulmonary exercise test (CPET). Results Patients with erectile dysfunction (57% of cases) demonstrated poorer physical performance, significantly correlated to the degree of erectile dysfunction. After cardiac rehabilitation, they walked shorter distances at the final six-minute walk test (490 ± 119 vs. 564 ± 94 m; p < 0.001); at CPET they sustained lower workload (79 ± 28 vs. 109 ± 34 W; p < 0.001) and reached lower oxygen uptake at peak effort (18 ± 5 vs. 21 ± 5 ml/kg per min; p = 0.003) and at anaerobic threshold (13 ± 3 vs.16 ± 4 ml/kg per min; p = 0.001). The positive predictive value of presence of erectile dysfunction was 0.71 for low peak oxygen uptake (<20 ml/kg per min) and 0.69 for reduced effort capacity (W-max <100 W). Conclusions As indicators of generalized underlying vascular pathology, presence and degree of erectile dysfunction may predict the severity of deterioration of effort tolerance in post-acute myocardial infarction patients. In the attempt to reduce the possibly associated long-term risk, an optimization of type, intensity and duration of cardiac rehabilitation should be considered.
authors.affiliation: 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.|2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: Leonida
authors.initials: L
authors.lastname: Compostella
authors.affiliation: 3 Department of Medicine, School of Emergency Medicine, University of Padua, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Compostella
authors.affiliation: 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.
authors.forename: Li Van Stella
authors.initials: LV
authors.lastname: Truong
authors.affiliation: 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.|2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Russo
authors.affiliation: 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Setzu
authors.affiliation: 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.|2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bellotto
mesh_terms: D000368:Aged; D015308:Anaerobic Threshold; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000072038:Cardiac Rehabilitation / Q000379:methods*; D015331:Cohort Studies; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000453:epidemiology*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D010807:Physical Endurance / Q000502:physiology*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012016:Reference Values; D012189:Retrospective Studies
keywords: Erectile dysfunction; cardiac rehabilitation; cardiopulmonary exercise test; myocardial infarction; physical performance; six-minute walk test