Left Ventricular Diastolic Function and Endothelial Function in Patients With Erectile Dysfunction Nevzat Uslu, MD, Mehmet Eren, MD, Sevket Gorgulu, MD*, Ahmet T. Alper, MD, Ahmet L. Orhan, MD, Aydin Yildirim, MD, Zekeriya Nurkalem, MD, and Huseyin Aksu, MD The aim of this study was to assess left ventricular diastolic function and forearm endo- thelial function in patients with erectile dysfunction (ED) without overt cardiovascular disease. Forearm endothelial function and diastolic Doppler parameters, including tissue Doppler imaging, were studied in 32 men with ED and 27 age-matched, healthy, male control subjects. Left ventricular diastolic function in patients with ED and the relation between endothelium-dependent vasodilation and the Doppler parameters of left ventric- ular diastolic function, including tissue Doppler imaging, were assessed. Endothelium- dependent vasodilation (4.1  3.3% vs 9.7  4.2%, p <0.001) as well as the mitral inflow E velocity (0.66  0.17 vs 0.80  0.16 m/s, p  0.01), the E/A ratio (the ratio of mitral inflow E velocity to mitral inflow A velocity; 0.91  0.3% vs 1.22  0.26%, p <0.001), and the E/Em ratio (the ratio of mitral A-wave velocity to early diastolic velocity in the annulus derived by tissue Doppler imaging; 7.4  2.7% vs 6.6  1.6%, p  0.03) were smaller in the ED group than in the control group. Deceleration time (228.6  61.6 vs 192.9  44.6 ms, p  0.03) and isovolumetric relaxation time (112.8  18 vs 94  15.9 ms, p <0.001) were also prolonged in the ED group compared with the control group. The mitral E-wave velocity (r  0.40, p  0.022), the E/A ratio (r  0.40, p  0.027), and the E/Em ratio (r 0.52, p  0.003) were related to endothelium-dependent vasodilation by univariate analysis. Only the E/Em ratio was correlated with endothelium-dependent vasodilation by multivariate analysis. In conclusion, this study indicates that endothelial function and left ventricular diastolic function are impaired in patients with ED without overt cardiovas- cular disease. © 2006 Elsevier Inc. All rights reserved. (Am J Cardiol 2006;97:1785–1788) It is well known that myocardial contraction itself is influ- enced by nitric oxide from coronary microvascular endothe- lium, and nitric oxide increases diastolic compliance and slightly shortens the duration of contraction, with little or no effect on systolic function. 1 The nitric oxide– cyclic guanosine- 3=5=-monophosphate system is also important in the patho- physiology of erectile dysfunction (ED). 2– 4 This system also plays a crucial role in maintaining the function of vascular endothelium. 5 Taking all this into account, we hypothesized that there may be generalized dysfunction in the nitric oxide system. If this is the case, there should also be impairment in endothelial function and left ventricular diastolic function. To ascertain the influence of possible generalized nitric oxide system dysfunction, we studied patients with ED without ath- erosclerosis or its main risk factors to minimize the effects of risk factors that may act with different mechanisms on ED, endothelial function, and left ventricular diastolic function. ••• Thirty-two outpatients with ED (mean age 54.6  9.8 years; consistent inability to achieve or sustain a sufficiently rigid erection for sexual intercourse) for 1 year and 27 healthy volunteers (mean age 51.8  7.1 years) as a control group from the hospital’s staff were enrolled in this study. The diag- nosis of ED was based on the International Index of Erectile Function-5 questionnaire and penile Doppler study. 6,7 None of the patients or controls had clinical evidence of coronary artery disease, diabetes mellitus, hypertension, malignancy, renal fail- ure, congestive heart failure, systemic inflammatory disease, or arrhythmias. None of the subjects was taking medications, alcohol, or vitamin supplements. All subjects gave informed consent before participation. The study protocol was approved by the local ethics committee. All patients and control subjects underwent clinical and electrocardiographic examination. The following risk fac- tors for atherosclerosis were assessed at the first evaluation: fasting glucose, total cholesterol, triglycerides, high- and low-density lipoproteinases, smoking status, and family his- tory of coronary artery disease. Renal and hepatic function tests were also done. A maximal exercise test was per- formed on all subjects according to Bruce’s protocol, and subjects with negative exercise test results were enrolled in the study. All subjects were asked to complete the interna- tional Index of Erectile Function-5 questionnaire to ascer- tain erectile performance. Transthoracic echocardiography was performed by 1 of the investigators, who had no information on the patients’ clinical data, using a Vivid Seven (GE Vingmed Ultrasound Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology Department, Istanbul, Turkey. Manuscript received September 20, 2005; revised manuscript received and accepted January 4, 2006. * Corresponding author: Tel: 00-90-216-3499120; fax: 00-90-216- 5504433. E-mail address: sevket5@yahoo.com (S. Gorgulu). 0002-9149/06/$ – see front matter © 2006 Elsevier Inc. All rights reserved. www.AJConline.org doi:10.1016/j.amjcard.2006.01.041