PD47-10: The Atherosclerotic Cardiovascular Disease risk score is a reliable tool to identify patients with arteriogenic erectile dysfunction at dynamic penile color doppler duplex ultrasound – findings from a real-life cross-sectional study

Edoardo Pozzi*, Massimiliano Raffo, Milan, Italy, Paolo Capogrosso, Varese, Italy, Giuseppe Fallara, Federico Belladelli, Christian Corsini, Daniele Cignoli, Luigi Candela, Nicolò Schifano, Alessia d'Arma, Luca Boeri, Eugenio Ventimiglia, Rayan Matloob, Milan, Italy, Vincenzo Mirone, Naples, Italy, Francesco Montorsi, Andrea Salonia, Milan, Italy

Introduction: The ASCVD (Atherosclerotic Cardiovascular Disease) risk score is a validated and standardised algorithm predicting the individual 10-year risk of developing acute cardiovascular events (CVs). Patients with erectile dysfunction (ED) are at greater risk of CVs; we aimed to i) apply the ASCVD score at a homogenous cohort of men undergoing dynamic penile color doppler duplex ultrasound (CDDU) for ED, and ii) explore its predictive ability to identify patients with arteriogenic and venogenic ED at CDDU.

Methods: Data of 188 consecutive patients undergoing CDDU for ED were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Serum hormones (total testosterone (tT) and luteinising hormone (LH)) were dosed for every patient. The ASCVD score was applied to the entire cohort. According to the ASCVD, patients were segregated into low (=7.5%) vs. intermediate/high risk (> 7.5%). Descriptive statistics was used to explore differences between the two groups. Logistic regression models tested the potential predictive role of ASCVD scores to predict pathological CDDU parameters (peak systolic velocity (PSV) < 35 cm/s and/or resistance index (RI) = 0.70). Local polynomial smoothing models graphically displayed the probability of pathological CDDU parameters at different ASCVD scores.

Results: Overall, median (IQR) age was 54 (43-60) yr. Of all, 52 (27.7%) patients reported severe ED, as for IIEF-EF = 11. Overall, 80 (42.6%) showed a pure arteriogenic ED and 15 (8%) pure venogenic ED at CDDU. Intermediate/high-risk patients (52.7%) were found to have lower IIEF-EF scores, higher BMI, higher CCI and presented with a greater rate of PDE5i non-responders compared to those with low-risk (47.3%) according to ASCVD (all p<0.005). Conversely, the two groups did not significantly differ in terms of CDDU parameters. At logistic regression analysis, the ASCVD risk score was identified as a strong predictor for arteriogenic ED at CDDU (OR: 1.07, 95% CI: 1.03-1.13, p = 0.007) after adjusting for BMI. Conversely, the ASCVD score was not identified as a predictor of pure venogenic ED (OR: 1.04, 95% CI: 0.98-1.1, p = 0.22). Figure 1 displays the probability of pathological findings at CDDU (PSV < 35 cm/sec vs. RI < 0.7) at different ASCVD scores.

Conclusions: The ASCVD risk score can be used as a valuable tool to identify patients with arteriogenic ED at CDDU in real-life settings. Since vasculogenic ED may anticipate CVs even by some years, the accurate identification of patients with deficient cavernosal arterial flow would certainly allow earlier and more effective cardiovascular prevention in this subset of patients.

Source of Funding: N/A