Abstract
Background: Erectile dysfunction is often the first clinically apparent manifestation of systemic vascular disease. We examined whether penile Doppler ultrasound can identify men with erectile dysfunction who harbor silent coronary artery disease.
Methods: In this retrospective, single-center observational study, 181 consecutive men aged 45–70 years with erectile dysfunction, at least one cardiometabolic risk factor, and no known cardiovascular disease underwent CCTA. Complete pharmacologically stimulated penile Doppler examinations were available in 173 men (153 maxitests and 20 minitests). Mean cavernous-artery PSV was measured 3 minutes after ICI. Coronary disease was graded with CAD-RADS; clinically relevant disease was defined as CAD-RADS >2.
Results: In the full cohort, 141 of 181 men (77.9%) had detectable coronary atherosclerosis and 71 (39.2%) had CAD-RADS >2. Among the 173 men with complete pharmacologically stimulated penile Doppler examinations, 139 (80.3%) had coronary atherosclerosis and 68 (39.3%) had CAD-RADS >2. In the maxitest subgroup, lower PSV remained independently associated with CAD-RADS >2 after adjustment for age and conventional risk-factor burden (odds ratio 1.05 per 1 cm/s decrease; 95% CI, 1.01–1.08). Discrimination was moderate (AUC 0.63), with an optimal threshold of 33 cm/s. Among 165 men classified as A1–A3, CAD-RADS >2 increased from 26.9% in A1 to 50.7% in A2 and 51.9% in A3 (trend p<0.001). PNORT was not associated with CAD-RADS >2.
Interpretation: Penile Doppler should not be regarded as a stand-alone coronary diagnostic test. It is a reproducible early vascular marker that can identify a subgroup of men with erectile dysfunction in whom targeted cardiovascular assessment, including CCTA when clinically appropriate, deserves consideration.
Central message: Erectile dysfunction is not merely a symptom; in men with cardiometabolic risk factors it may be the first clinically visible expression of systemic vascular disease.