Objectives: Recommending general dynamic penile color doppler ultrasound (D-PCDU) screening in patients with erectile dysfunction (ED) has been questioned due to an inadequate cost-benefit ratio. The aim of the present study is to asses the validity of different risk scores in the identification of patients being screened for arteriogenic ED at D-PCDU.
Design and methods: A consecutive series of 738 (mean age 53.6±9.2 years) patients with ED was studied. All patients underwent D-PCDU. Arteriogenic ED was defined when peak systolic velocity (PSV) was lower than 25 cm/s. The assessment of cardiovascular risk was evaluated using different risk engines, derived from the Framingham, the PROCAM and the Progetto Cuore studies. An iterative ROC curve analysis was used to determine the most proper threshold for different scales for the screening of arteriogenic ED. Sensitivity and specificity at those thresholds were calculated.
Results: Among the patients studied, 52 (7%) had PSV<25 cm/s. The area under the ROC curves for pathological PSV in relation to cardiovascular risk estimated with different engines was 0.762±0.03, 0.716±0.03 and 0.667±0.03 for Progetto Cuore, Framingham and PROCAM engines, respectively. Sensitivity and specificity of Progetto Cuore estimated risk were 67, 71% when a threshold of 15% was chosen. Corresponding figures for Framingham and PROCAM engine were 74, 57% and 69, 55%, respectively.
Conclusions: If D-PCDU is performed only on patients with cardiovascular risk >15%, who represent about 1/4 of all patients (26.8%), as estimated by Progetto Cuore, about 70% of cases of arteriogenic ED can be identified. This means that well over two thirds of cases can be diagnosed by performing D-PCDU on one patient out of four. Estimated cardiovascular risk, assessed through risk engines, could be used to identify patients who should undergo D-PCDU evaluation for the diagnosis of arteriogenic ED.
03 - 07 May 2008
European Society of Endocrinology