Introduction: Erectile dysfunction (ED) may be considered a clinical manifestation of a generalized vascular disease affecting also the penile arteries. The aim of this prospective study was to investigate arterial function determinants of wall motion abnormalities during stress testing in men with ED.

Methods: 188 consecutive asymptomatic men (40–60 y/o), with non-psychogenic and non-hormonal ED underwent:(1) dobutamine stress echocardiography (DSE) (2) evaluation of aortic stiffness with carotid-femoral pulse wave velocity (PWV) and (3) penile vascular assessment using color duplex sonography. Criteria of positivity were regional dysfunction >2 segments demonstrated by DSE. A mean peak systolic velocity (PSV) below 25 cm/sec was considered to indicate severe arterial insufficiency.

Results: 49 ED patients (26 %) exhibited regional wall motion abnormalities. Men with abnormal DSE compared to men without stress evidence for myocardial ischemia had higher prevalence of multiple cardiovascular risk factor status (> 2 risk factors) (36 vs 22 %, P<0.001), higher PWV (8.8 ± 1.2 vs 8.1±1.3 m/s, P<0.01) and lower penile Doppler velocities (28.2±8 vs 33.9±9 cm/s, P<0.001). Receiver operating characteristic curve analysis for the prediction of DSE positivity showed that PWV value > 8.2 m/s combined with PSV<26.5 cm/s was the best predictor of DSE positivity (61 % sensitivity, 82% specificity, and 83% positive predictive value).

Conclusion: In asymptomatic men with ED increased PWV and decreased PSV values correlate significantly with an increased likelihood of exhibiting regional wall motion abnormalities during DSE and the greatest gain is found in men with severe penile arterial insufficiency and a stiffer aorta.