TY - JOUR

T1 - Erectile Dysfunction Is Associated with Left Ventricular Diastolic Dysfunction

T2 - A Systematic Review and Meta-analysis

AU - Durukan, Emil

AU - Jensen, Christian Fuglesang S.

AU - Skaarup, Kristoffer Grundtvig

AU - Østergren, Peter Busch

AU - Sønksen, Jens

AU - Biering-Sørensen, Tor

AU - Fode, Mikkel

N1 - Publisher Copyright: © 2023

PY - 2023

Y1 - 2023

N2 - Context: Erectile dysfunction (ED) is associated with an increased risk of cardiovascular morbidity and mortality. Objective: To systematically review and analyze the cardiac structure and function in men with ED assessed with echocardiography. Evidence acquisition: We performed a systematic review and meta-analysis according to the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched PubMed and the Cochrane Library on June 2, 2022, and included studies evaluating cardiac structure and function using echocardiography in men with ED compared with controls without ED. The Newcastle-Ottawa Quality Assessment Scale was used for assessing the quality of studies. We analyzed the mean differences in left ventricular ejection fraction (LVEF), the ratio of early transmitral filling velocity to early diastolic mitral annular velocity (E/e′), ratio of the early to late diastolic transmitral flow velocity (E/A), isovolumic relaxation time (IVRT), and left ventricular mass index (LVMi) in a random-effect model computed using means and standard deviations. The review was preregistered with PROSPERO (CRD42022337183). We received no funding. Evidence synthesis: We included ten studies with 763 men diagnosed with ED (mean age: 55.6 yr) and 358 control men (mean age: 54.4 yr). E/e′ was significantly worse in men with ED than in controls (mean absolute difference = 1.17, 95% confidence interval or CI [0.68, 1.65], p < 0.005). No significant differences were observed in LVEF, E/A, IVRT, or LVMi (–0.06, 95% CI [–1.06, 0.95], p = 0.91; –0.06, 95% CI [–0.24, 0.13], p = 0.55; 11.76, 95% CI [–0.88, 24.39], p = 0.07; and 4.37, 95% CI [–2.91, 11.65], respectively). The studies exhibited heterogeneity regarding study populations, reported echocardiography data, and variations in adjustments for confounding factors. Conclusions: Left ventricle diastolic dysfunction, as assessed by E/e′, was more frequent in men with ED than in matched controls without ED. The results imply that echocardiography may be useful in the cardiovascular evaluation of men with ED to help identify myocardial impairment. Patient summary: This study reviewed for the first time previous research on cardiac structure and function in men with erectile dysfunction (ED), as assessed by echocardiography. We found that men with ED, compared with men without ED, had a higher ratio of early transmitral filling velocity to early diastolic mitral annular velocity, indicating a potentially higher rate of impaired diastolic function—a potential early indicator of heart disease. Identification of early signs of heart problems in men with ED may help initiate necessary lifestyle modifications or preventative therapies before the development of heart disease. However, more research is required to determine the clinical utility of using echocardiography as a risk assessment method.

AB - Context: Erectile dysfunction (ED) is associated with an increased risk of cardiovascular morbidity and mortality. Objective: To systematically review and analyze the cardiac structure and function in men with ED assessed with echocardiography. Evidence acquisition: We performed a systematic review and meta-analysis according to the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched PubMed and the Cochrane Library on June 2, 2022, and included studies evaluating cardiac structure and function using echocardiography in men with ED compared with controls without ED. The Newcastle-Ottawa Quality Assessment Scale was used for assessing the quality of studies. We analyzed the mean differences in left ventricular ejection fraction (LVEF), the ratio of early transmitral filling velocity to early diastolic mitral annular velocity (E/e′), ratio of the early to late diastolic transmitral flow velocity (E/A), isovolumic relaxation time (IVRT), and left ventricular mass index (LVMi) in a random-effect model computed using means and standard deviations. The review was preregistered with PROSPERO (CRD42022337183). We received no funding. Evidence synthesis: We included ten studies with 763 men diagnosed with ED (mean age: 55.6 yr) and 358 control men (mean age: 54.4 yr). E/e′ was significantly worse in men with ED than in controls (mean absolute difference = 1.17, 95% confidence interval or CI [0.68, 1.65], p < 0.005). No significant differences were observed in LVEF, E/A, IVRT, or LVMi (–0.06, 95% CI [–1.06, 0.95], p = 0.91; –0.06, 95% CI [–0.24, 0.13], p = 0.55; 11.76, 95% CI [–0.88, 24.39], p = 0.07; and 4.37, 95% CI [–2.91, 11.65], respectively). The studies exhibited heterogeneity regarding study populations, reported echocardiography data, and variations in adjustments for confounding factors. Conclusions: Left ventricle diastolic dysfunction, as assessed by E/e′, was more frequent in men with ED than in matched controls without ED. The results imply that echocardiography may be useful in the cardiovascular evaluation of men with ED to help identify myocardial impairment. Patient summary: This study reviewed for the first time previous research on cardiac structure and function in men with erectile dysfunction (ED), as assessed by echocardiography. We found that men with ED, compared with men without ED, had a higher ratio of early transmitral filling velocity to early diastolic mitral annular velocity, indicating a potentially higher rate of impaired diastolic function—a potential early indicator of heart disease. Identification of early signs of heart problems in men with ED may help initiate necessary lifestyle modifications or preventative therapies before the development of heart disease. However, more research is required to determine the clinical utility of using echocardiography as a risk assessment method.

KW - Cardiac disease

KW - Cardiovascular disease

KW - Echocardiogram

KW - Echocardiography

KW - Erectile dysfunction

KW - Left ventricular diastolic dysfunction

U2 - 10.1016/j.euf.2023.06.001

DO - 10.1016/j.euf.2023.06.001

M3 - Review

C2 - 37355365

AN - SCOPUS:85162879166

VL - 9

SP - 903

EP - 912

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

IS - 6

ER -