Objectives: As silent myocardial ischemia (SMI) is a strong predictor of early death especially in patients with diabetes mellitus (DM), our study aims to evaluate the relationship between erectile dysfunction (ED) severity and SMI in DM patients using the multidetector computed tomography coro- nary angiography (MDCT-CA), and to identify predicators of SMI.
Material and Methods: The study included 20 diabetic patients with ED with no past and/or present cardiac symptoms. Erectile function was evaluated with sexual health inventory for men (SHIM), erection hardness score (EHS), and mean penile circumferential change (MPCC) by Erectometer. MDCT-CA was used for SMI diagnosis.
Results: Data was presented as mean ± SD, median (25th-75th interquartile range), or percentage (%) when appropriate. Patients characteristics showed age 61.45 ± 10.7 years, BMI 27.3 ± 6.93 kg/m2, 95% type 2 DM, DM history 6 (4-15) years, 45% hypertension, 30% Dyslipidemia, 55% smoking, HbA1c 7.38 ± 1.21 %, HOMA-insulin resistance 15.55 (6.95- 37.75) mU/ml, HDL-Cholesterol 44.24 ± 9.35 mg/dl, and LDL-Cholesterol 98.67 ± 32.88 mg/dl. Patients Hormonal profile showed total testosterone 5.53 ± 2 nmol/l, free testos- terone 7.75 ± 2.46 pg/ml, and LH 6.1(5.1-7.7) mIU/ml. Erectile evaluation showed ED history 3 (2-7) years, SHIM score 5 (2.5-8.5), EHS 2 (1-2), MPCC 14.5 ± 9.46 mm. MDCT-CA showed coronary artery stenosis in 13/20 (65%) in the form of one-vessel 6/20 (30%), 2-vessels 2/20 (10%), 3-vessels 5/20 (25%) affection. Half of the patients showed 50% vessel lumen obstruction with the left anterior descend- ing coronary artery was the most common affected (55%). Pearson correlation test demonstrated that maximum coronary artery stenosis was positively correlated with age (r = 0.529, p=0.016), and negatively correlated with EHS (r= -0.449, p =0.046). Multivariate analysis using age & EHS parameters showed that age was the only predicator for SMI (p = 0.04). Conclusions: MDCT-CA could be a useful tool to identify SMI in DM patients with ED especially in those with advanced age, and/or sever ED. A controlled clinical trial with a larger patient sample size is needed.