الفهرس | Only 14 pages are availabe for public view |
Abstract Erectile dysfunction is defined as the inability to initiate or maintain an erection long enough to have a satisfying sexual relationship. Erectile dysfunction (ED) is the most common sexual dysfunction in males, affecting 15% of men in their 40s and 50s, 45 percent of men in their 60s, and 70% of men over the age of 70. Despite the fact that ED is a multifaceted process, vascular insufficiency is a common cause, accounting for up to 80% of cases. Many researches have shown that CVD risk factors such as diabetes mellitus (DM), hypertension, old age, insulin resistance, smoking, high body mass index (BMI), increased cholesterol, and low-density lipoprotein (LDL) levels are also risk factors for erectile dysfunction. In addition to the fact that ED is linked to a number of cardiovascular risk factors in men, it is increasingly considered an early sign of atherosclerosis and CVD. According to studies, ED symptoms appear 2–3 years before clinically significant coronary artery disease and 3–5 years before cardiovascular events, implying that ED can be considered a new cardiovascular risk factor and an individual predictor of cardiovascular events. The size of the artery hypothesis explains the association between ED and CAD, implying that atherosclerosis damages small vessels more than bigger vessels, and that when atherosclerosis affects the coronary circulation, the damage to the penile artery is greater. Pharmaco-penile duplex ultrasonography is an effective, minimally invasive approach for individuals with erectile dysfunction who have failed to respond to oral erectogenic medications (ED). In a Summary 88 variety of different disorders, such as Peyronie’s disease, priapism, penile fracture, or masses involving deep tissues of the penis, PPDU is used to offer an anatomic and functional vascular assessment. PPDU is used as part of the ED evaluation to determine the quality of arterial blood flow and the sufficiency of veno-occlusive mechanisms, both of which are required for a good erection. Recently, this imaging technique has become increasingly useful in the early detection of otherwise silent coronary artery disease (CAD) in men who present with ED as their initial symptom. The most common procedure for diagnosing heart abnormalities is electrocardiography (ECG). Over the last two centuries, the electrocardiogram (ECG) has evolved in both technology and clinical utility. In patients with coronary artery disease, a fragmented QRS is a reliable ECG sign of myocardial ischemia. As a new, useful, and reliable ECG finding, fragmented QRS (fQRS) has sparked a lot of interest. It was defined as the presence of notched R or S waves in the original QRS complex that aren’t followed by a typical branch block or extra spikes akin to the RSR model 120 ms. They believed it as a useful indicator in determining prognosis for patients with CAD. It was discovered to be linked to underlying structural cardiac problems, as well as a poor prognosis. Researchers have linked the presence of fQRS to sudden cardiac death and the recurrence of cardiac disorders. Summary 89 The aim of this study was to detect a fragmented QRS on an ECG could be a better and earlier indicator of cardiovascular involvement in patients with arteriogenic ED than PPDU. Our study was conducted in the period from 2019 to 2021, cases were obtained from andrology clinic of Menoufiya university hospital. During this study, 100 cases were studied. Their ages ranged from 41 to 66 years old. All cases were subjected to the following: 1. Detailed history taking. 2. Thorough clinical examination. 3. Imaging studies including PPDU and ECG for detecting fragmented QRS. Cases were classified according to IEEF to mild group (25 cases), mild to moderate group (35 cases), moderate group (25 cases) and sever group (15 cases). There was a significant difference between studied groups regarding PPDU results as 46.7% of cases with severe and 44% of cases with moderate erectile dysfunction had arteriogenic ED. While only 28.6% of mild to moderate had arteriogenic ED and 20% of mild cases had arteriogenic ED. The presence of fragmented QRS was significantly different among the studied groups as 66.7% of patients with severe and 60% of patients with moderate erectile dysfunction had fragmented QRS while 28.6% of patients with mild - moderate and 24% of patients with mild erectile dysfunction had fragmented QRS. There was significant relation between dopplex results of cases regarding the presence of fragmented QRS as 56.1% of cases with Summary 90 fragmented QRS had arteiogenic dopplex. While only 22% with fragmented QRS had venogenic and only 22% with fragmented QRS had normal results. Fragmented QRS was more specific 83% than sensitive 56% with accuracy of 72% in arteriogenic ED prediction. |