Flaccid Penile Acceleration as a Marker of Cardiovascular Risk in Men without Classical Risk Factors

Authors

  • Giulia Rastrelli MD, PhD,

    1. Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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  • Giovanni Corona MD, PhD,

    1. Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
    2. Endocrinology Section, Maggiore Hospital, Bologna, Italy
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  • Francesco Lotti MD,

    1. Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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  • Antonio Aversa MD, PhD,

    1. Department of Experimental Medicine, University of Rome “La Sapienza”, Rome, Italy
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  • Marco Bartolini MD,

    1. Diagnostic Imaging Department, Azienda Ospedaliera Univarsitaria Careggi, Florence, Italy
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  • Mario Mancini MD,

    1. Urology Unit, San Paolo Hospital, Milan, Italy
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  • Edoardo Mannucci MD,

    1. Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy
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  • Mario Maggi MD

    Corresponding author
    1. Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
    • Corresponding Author: Mario Maggi, MD, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence 50139, Italy. Tel: +39 0554271415; Fax: +39 0554271413; E-mail: m.maggi@dfc.unifi.it

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  • Authors Rastrelli and Corona equally contributed to the manuscript.

Abstract

Introduction

Conventional cardiovascular (CV) risk factors identify only half of subjects with incident major adverse CV events (MACE). Hence new markers are needed in high CV risk subjects, as those with erectile dysfunction (ED). A role for dynamic peak systolic velocity (D-PSV) at penile color Doppler ultrasound (PCDU) has been suggested, but it is operator dependent and time consuming. Flaccid penile acceleration (FPA) is a PCDU parameter that reflects PSV, the systolic rise time (SRT), and end diastolic velocity (EDV), arithmetically defined as (PSV−EDV)/SRT.

Aim

The study aims to verify, in a large series of ED patients, whether FPA has a role in predicting MACE.

Methods

A selected series of 1,903 patients (aged 54.6 ± 11.7) with a suspected organic component for ED was retrospectively studied from January 2000 until July 2012. A subset of this sample (n = 622) was enrolled in a longitudinal study that ended in December 2007.

Main Outcome Measures

Several clinical, biochemical, and instrumental (PCDU) parameters were studied.

Results

Decreased FPA levels were associated with worse metabolic profile and sexual symptoms. In addition, FPA was positively associated with both total and calculated free testosterone. In the longitudinal study, unadjusted incidence of MACE was significantly associated with lower baseline FPA. When FPA was introduced in a multivariate model, along with D-PSV, after adjusting for age and Chronic Disease Score, lower FPA, but not D-PSV, was associated with incident MACE in lower-risk—i.e., younger (HR = 0.48 [0.23–0.99]), nonhypertensive (HR = 0.59 [0.38–0.92]), nonobese (HR = 0.68 [0.49–0.96]), or nondiabetic (HR = 0.67 [0.49–0.96] subjects; all P < 0.05—but not in higher-risk ones. FPA demonstrated a threshold effect in predicting MACE at a value <1.17 m/s2 which showed a threefold increase in incidence of MACE in apparently lower-risk individuals.

Conclusions

FPA is an easily obtained PCDU parameter and capable of identifying adverse metabolic and CV profiles, particularly in apparently lower-risk individuals with ED. Rastrelli G, Corona G, Lotti F, Aversa A, Bartolini M, Mancini M, Mannucci E, and Maggi M. Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors. J Sex Med 2014;11:173–186.

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