Article

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.

Langue : ANGLAIS