The application of digital pulse amplitude tonometry to the diagnostic investigation of endothelial dysfunction in men with erectile dysfunction

Aversa, Antônio; Francomano, Davide; Bruzziches, Roberto; Pili, M; Natali, M.; Spera, Giovanni; Lenzi, Andrea

doi:10.1111/j.1439-0272.2009.00998.x

Cited by 31 publications

(40 citation statements)

References 26 publications

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“…In addition, it is similar to flow-mediated dilation in representing a true physiological reflection of peripheral endothelial function Tamler & Bar-Chama (2008). Recently, its application in men with ED was tested, but an increased arterial stiffness rather than an impaired reactive hyperaemia demonstrated by RH-PAT was found in patients with vascular ED independently of CVRF presence Aversa et al (2011).…”

Section: Discussionmentioning

confidence: 99%

“…Patients were instructed to have a light meal on the morning of the exam and to refrain from exercise, smoking and caffeine consumption on that day. Peripheral wave amplitude was assessed before and during reactive hyperaemia (RH) by PAT (Endo-PAT 2000; Itamar Medical Ltd., Caesarea, Israel) as previously described Aversa et al (2011). Following a 10-min acclimatization period, 5-min RH-PAT baseline signals were recorded using plethysmographic finger cuffs, placed on the index finger of both hands.…”

Section: Peripheral Arterial Tonometry Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

210 Endothelial function in patients with metabolic syndrome and erectile dysfunction: A question of Angiopoietin imbalance?

Tomada¹,

Tomada²,

Botelho³

et al. 2013

European Urology Supplements

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SUMMARYErectile dysfunction (ED) is a highly prevalent disease whose aetiology is mostly vasculogenic. It is nowadays considered a marker of future cardiovascular events reflecting the underlying endothelial dysfunction, the common link with the metabolic syndrome (MetS). The recent association between MetS, endothelial dysfunction and peripheral artery disease, but not with coronary artery disease (CAD), suggests that the pathophysiologies of CAD and peripheral artery disease may be distinct. Moreover, several recent studies support an emerging role for an imbalance of angiogenic growth factor levels like Angiopoietin 1 and 2 in cardiovascular disease, considering its intimate association with chronic low-grade inflammation. We aim to find a correlation between Angiopoietins levels and systemic and local endothelial function in MetS and ED patients. Forty-five MetS patients with ED were enrolled. ED severity was assessed by International Index of Erectile Function questionnaire (IIEF5) and penile duplex Doppler ultrasound (PDDU). Endothelial function was assessed by Peripheral arterial tonometry (PAT), and serum asymmetric dimethylarginine (ADMA), Ang1 and Ang2 levels. Obesity and hypertension were the most frequent MetS parameters (91.1 and 88.9% respectively). Severe ED was present in 35.6% of patients. Penile haemodynamic was impaired in 77.5%. Endothelial dysfunction (PAT criteria) was present in 40.9% of patients. Ang2 levels were significantly higher in men with abdominal obesity. We observed an inverse correlation between Ang1 and peak systolic velocity, and in patients with penile arterial dysfunction, Ang1 levels were significantly higher and Ang2/Ang1 ratio significantly lower, than patients with normal arterial function. Neither ADMA nor PAT parameters were correlated with ED severity evaluated by IIEF5 or PDDU exam. In conclusion, there is an imbalance of angiopoietins in MetS and ED patients. The absence of correlation with PAT or ADMA levels suggests that angiopoietins may be early markers of endothelial dysfunction in this population of higher cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

Section: Peripheral Arterial Tonometry Evaluationmentioning

confidence: 99%

210 Endothelial function in patients with metabolic syndrome and erectile dysfunction: A question of Angiopoietin imbalance?

Tomada¹,

Tomada²,

Botelho³

et al. 2013

European Urology Supplements

View full text Add to dashboard Cite

show abstract

“…45 AIx and hyperlipidemia: Patients with hypercholesterolemia have a higher central pulse pressure and stiffer blood vessels than matched controls, despite similar peripheral blood pressures. These hemodynamic changes may contribute to the increased risk of cardiovascular disease associated with hypercholesterolemia, and assessment may improve risk stratification.…”

Section: The Augmentation Indexmentioning

confidence: 99%

Measuring and Evaluating Function, Impairment, and Change with Intervention

Fried¹

2014

Erectile Dysfunction as a Cardiovascular Impairment

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“…First and foremost is the stimulation of the cavernosal nerves to synthesize and release nitric oxide (NO) from its nerve terminals onto the smooth muscle cells of both the corpora cavernosa and the penile arterial system. 14,[15][16][17] This neuronally derived NO, which is synthesized from the neuronal nitric oxide synthase (nNOS) enzyme located within the cytosolic (nonmembrane-bound fluid within the cytoplasm) fraction of the neural cell, causes the relaxation of smooth muscle in the media of the penile arterial vessels (arterial vasodilatation increases blood flow to the penis) and within the cavernosal bodies (which open the sinusoids to provide a place to store the increase in penile blood flow). There is no direct scientific evidence today to suggest that the initiation of the erection involves the secretion of NO by the endothelium of either the cavernosal blood vessels or the sinusoids 18 as is shown by the lack of NOS activity within the membrane-bound fraction of the cavernosal tissue 19 and by the ability of eNOSdeficient mice to have normal neurogenically mediated erectile responses.…”

Section: Physiology Of Edmentioning

confidence: 99%

Hypertension: The Link Between Erectile Dysfunction and Coronary Artery Disease

Rajfer

Miner

2013

Journal of Men's Health

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The ability to attain and then maintain an erection is the result of a dynamic balance between arterial inflow and cavernosal outflow. Any imbalance that either decreases arterial inflow and/or increases cavernosal outflow may result in symptomatic erectile dysfunction (ED). Current data suggest that vasculogenic ED is of arterial origin and primarily the result of the development of systemic endothelial dysfunction (EnD). Since systemic EnD is heralded as an early marker of cardiovascular disease, specifically coronary artery atherosclerotic heart disease (CAD), it has been suggested that the onset of ED can be used as a marker for either the presence, or future development, of CAD. However, the failure to find arterial dysfunction in some young men with largely vasculogenic ED, combined with the recognition that most men with ED, regardless of age, appear to have at least some cavernosal smooth muscle dysfunction, has prompted a reexamination of the roles of vascular endothelium and the cavernosal smooth muscle in the development of aging-related ED, as well as a reexamination of the significance of ED as a marker of subsequent cardiovascular disease. The unifying concept that explains all these events is the aging-related apoptosis that occurs within vascular smooth muscle. In the penis, this smooth muscle apoptosis will cause cavernosal veno-occlusive dysfunction (CVOD), which initially affects a man's refractory period. In the peripheral vascular system, the apoptotic process leads to an increase in peripheral vascular resistance, and patients may present with hypertension. Hypertension and CVOD, then, represent the same pathophysiologic disorder in two different organ systems.

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The application of digital pulse amplitude tonometry to the diagnostic investigation of endothelial dysfunction in men with erectile dysfunction

Cited by 31 publications

References 26 publications

210 Endothelial function in patients with metabolic syndrome and erectile dysfunction: A question of Angiopoietin imbalance?

210 Endothelial function in patients with metabolic syndrome and erectile dysfunction: A question of Angiopoietin imbalance?

Measuring and Evaluating Function, Impairment, and Change with Intervention

Hypertension: The Link Between Erectile Dysfunction and Coronary Artery Disease

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