Erectile Dysfunction in Heart Failure: Correlation with Severity, Exercise Performance, Comorbidities, and Heart Failure Treatment

Abstract

Erectile dysfunction (ED) is frequent in males with chronic heart failure (HF) with a severe impact on quality of life for many individuals. The correlation of ED with age and HF severity, comorbidity, and treatment is unclear. We evaluated the correlation between ED and HF severity, treatment, and comorbidity. One hundred one HF patients aged ≤70 years, with left ventricular ejection fraction ≤40%, and stable clinical condition took part in the study. We measured: (i) hemoglobin, glycemia, glicated hemoglobin, creatinine, cholesterol, thyroid-stimulating-hormone, C-reactive-protein, total/free testosterone; (ii) ED, depression, urological symptoms, and signs of low testosterone by means of questionnaires; and (iii) HF severity by means of echo, brain natriuretic peptide, and cardiopulmonary exercise test. ED was measured by means of International Index of Erectile Function-5 questionnaire and its score was correlated with exercise cardiopulmonary test parameters, HF severity, treatment and HF comorbidities. ED prevalence was 69.3%, 81.1%, and 56% in total population and in patients with and without coronary artery lesions, respectively. ED was absent in 31 while it scored mild, mild to moderate, moderate and severe in 15, 18, 12, 25 individuals, respectively. Sexual activity requires, in the orgasmic phase, an oxygen consumption (VO₂) between 10 and 14 mL/min/kg. In none of the individuals with peakVO₂ < 10 mL/min/kg was sexual function normal or slightly impaired, while in 10/29 of patients with peakVO₂ between 10 and 14 mL/min/kg there was a normal or slightly reduced sexual performance. On monovariable analysis, several parameters were correlated with ED, but at multivariable analysis only age (P = 0.002), hemoglobin (P = 0.042), diabetes (P = 0.040), and use of diuretics (P = 0.052) remained so. ED is frequent in HF. A normal or only slightly impaired sexual activity is possible with peakVO₂ > 10 mL/min/kg. On multivariable analysis, only age, diabetes, use of diuretics, and hemoglobin are related to ED. Apostolo A, Vignati C, Brusoni D, Cattadori G, Contini M, Veglia F, Magrì D, Palermo P, Tedesco C, Doria E, Fiorentini C, Montorsi P, and Agostoni P. Erectile dysfunction in heart failure: Correlation with severity, exercise performance, comorbidities, and heart failure treatment. J Sex Med 2009;6:2795–2805.