Abstract 13679: Incremental Value of Poor Penile Arterial Inflow for the Prediction of Significant Coronary Artery Stenosis in Asymptomatic Hypertensive Patients with Increased Carotid Intima Media Thickness: A Prospective Angiographic Study
Objective: Aortic stiffness and carotid intima media thickness (IMT) are markers of subclinical vascular damage in patients with essential hypertension. Reduced penile peak systolic velocity (PPSV) is associated with increased risk for cardiovascular events as well as the degree and distribution of atherosclerotic lesions. This study was undertaken to ascertain whether poor penile inflow adds incremental value beyond aortic stiffness and IMT evaluation for predicting coronary artery disease (CAD) in hypertensive ED patients.
Methods: 181 consecutive asymptomatic ED patients with hypertension were prospectively evaluated for CAD. All patients underwent dynamic (after prostaglandin E1 stimulation) penile Doppler ultrasonography, carotid-femoral pulse wave velocity (PWV) and carotid IMT evaluation. Mean PPSV values below 25 cm/sec are considered to indicate severe arterial insufficiency (SAI).
Results: Coronary angiography revealed significant stenosis in 43 (24%) patients with a positive stress test. SAI was found in 23 of 43 (53.5%) CAD patients and in 30 of 138 (22%) non CAD subjects (P=0.005). The prevalence of high PWV and IMT values (≥75th percentile, 9.6 m/s and 0.94 mm, respectively) was significantly higher among CAD patients than among non CAD subjects (39.5% vs 19.4 %, P=0.004 and 55.2% vs 26.7%, P<0.001, respectively). By conditional logistic regression analysis, SAI conveyed no additional predictive information beyond high PWV values. On the contrary, SAI confers an incremental value over high IMT values in predicting CAD (OR: 4.62 CI: 2.34-9.57, P<0.001, figure).
Conclusion: Adjunctive assessment of PPSV with carotid wall thickness enhances the detection of silent CAD among hypertensive ED patients.
- © 2011 by American Heart Association, Inc.