August 11, 2015Annals of Noninvasive Electrocardiology8 citationsOpen Access
Chronotropic Incompetence and Dynamic Postexercise Autonomic Dysfunction Are Associated with the Presence and Severity of Erectile Dysfunction
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Key Result
The presence of erectile dysfunction was associated with lower calculated exercise capacity (P<0.001) and reduced chronotropic index (P<0.01) compared to men without erectile dysfunction.
Study Design
Type
Observational (n=230)
Structured PICO
Are chronotropic incompetence and abnormal heart rate recovery during exercise stress testing associated with the presence and severity of erectile dysfunction?
P
Population
230 men, comprising 180 with erectile dysfunction and 50 without, who underwent maximal exercise stress testing.
E
Exposure
Presence and severity of erectile dysfunction (ED)
C
Comparator
Men without erectile dysfunction
O
Outcome
Exercise stress testing parameters including exercise capacity (METS), peak exercise time, HR at six METS, peak exercise, HR recovery (HRR) at 1 and 2 minutes, and chronotropic index (CI)surrogate
Erectile dysfunction is associated with impaired exercise capacity, chronotropic incompetence, and abnormal heart rate recovery, suggesting a pathophysiological link to systemic endothelial dysfunction and increased cardiovascular risk.
Main Result
p-value: p=<0.001
Abstract
BACKGROUND: Exercise stress testing (EST) is crucial to determine cardiovascular (CV) risk in men with erectile dysfunction (ED). Low exercise workload, a slower rate of recovery following exercise, and an impaired capacity to increase heart rate (HR) during exercise testing (chronotropic incompetence) are independent predictors of adverse CV outcomes. Aim of this study was to investigate the association between ED and EST parameters. METHODS: A total of 180 ED patients and 50 men without ED underwent maximal EST. Exercise parameters including exercise capacity (metabolic equivalents, METS), peak exercise time, HR at six METS, peak exercise, HR recovery (HRR) at 1 and 2 minutes and chronotropic index (CI) were evaluated in all individuals. Endothelial function was evaluated with flow-mediated dilatation (FMD) of the brachial artery. RESULTS: ED patients had lower peak exercise time and thus lower calculated exercise capacity (P < 0.001) and reduced CI (P < 0.01) compared to men without ED. There was a significant association of ED severity with duration of exercise, peak workload, HRR 2 minutes after exercise, and CI (all P < 0.05). There also was a positive relation of HRR and CI with FMD (all P < 0.05). CONCLUSIONS: This study shows interrelationships between exercise capacity, HRR, CI, and ED. Abnormal HRR and CI are associated with systemic endothelial dysfunction. These findings imply pathophysiological links and may have important implications for the estimation of cardiovascular risk in ED patients.