Erectile Dysfunction as a Marker of Subclinical Biventricular Diastolic Dysfunction: A Prospective Echocardiographic Study

Objective: Erectile dysfunction (ED) and cardiovascular disease share common vascular pathologies, particularly endothelial dysfunction and atherosclerosis. Growing evidence indicates that ED may serve as an early indicator of underlying cardiac abnormalities, particularly diastolic dysfunction (DD), even in the absence of clinically apparent cardiovascular disease.

Method: This prospective, single-center study included 87 patients with ED, matched with 53 healthy controls based on age and body mass index. The severity of ED was assessed using the International Index of Erectile Function (IIEF) and categorized as mild, moderate, or severe. Diastolic dysfunction was evaluated according to established guidelines.

Results: Patients with ED exhibited significant impairments in left ventricular diastolic function, including reduced E/A and e′ velocities, prolonged isovolumetric relaxation time (IVRT), and left atrial (LA) enlargement. A correlation was observed between the severity of ED and worsening right ventricular (RV) diastolic indices, specifically reduced RV e′ and elevated RV E/e′ ratios. Notably, LA enlargement and prolonged IVRT emerged as independent predictors of ED.

Conclusion: Erectile dysfunction is independently associated with subclinical biventricular DD, even in the absence of overt cardiovascular disease. Echocardiography may help detect subclinical cardiac dysfunction in men with ED and improve cardiovascular risk assessment.

Keywords: Diastolic dysfunction, erectile dysfunction, transthoracic echocardiography