Does Erectile Dysfonction Allow to Evaluate Subendocardial Viability Among Treated Patients With Hypertension ?

Official title

Does Erectile Dysfonction is Correlated to Subendocardial Viability Among Treated Patients With Hypertension ?

Overview

Erectile dysfunction (ED) is associated with subclinical atherosclerosis and may precede clinically apparent coronary artery disease by two to five years. It may therefore serve as an early warning sign of cardiovascular disease and help identify patients who could benefit from intensified cardiovascular risk-factor management. The subendocardial viability ratio (SEVR), also known as the Buckberg index, is obtained noninvasively from radial artery applanation tonometry. SEVR reflects the balance between myocardial oxygen supply and demand and has been associated with coronary flow reserve in patients with hypertension. The DEVISE study will compare SEVR between treated men with hypertension who have ED with those who do not. The study will also examine the associations between ED severity and arterial stiffness, central hemodynamics, exercise capacity, left ventricular mass, coronary artery calcium, high-sensitivity C-reactive protein, cardiovascular risk, and quality of life. The question addressed in our study is whether an alteration in subendocardial viability represents subclinical coronary disease associated with ED.

Detailed description

DEVISE is a monocenter, prospective, noninterventional, cross-sectional, observational study. Consecutive adult men receiving pharmacological treatment for hypertension who are admitted to the hypertension day hospital unit at Lariboisière Hospital for assessment of hypertension-mediated organ damage will be screened.

Participants will complete the five-item International Index of Erectile Function (IIEF-5) questionnaire. Participants will be classified into two groups according to the presence or absence of ED. ED is defined as an IIEF-5 score of 21 or lower and will be further categorized as mild (17-21), mild-to-moderate (12-16), moderate (8-11), or severe (5-7).

All cardiovascular examinations are performed as part of routine care except for the completion of the IIEF-5 and SF-12 questionnaires. Radial artery applanation tonometry will be used to derive the central aortic pressure waveform and calculate systolic arterial velocity reserve (SEVR), central pulse pressure, pulse pressure amplification, and the augmentation index. Carotid-femoral pulse wave velocity will be measured as an index of aortic stiffness. Other assessments will include a bicycle exercise test, echocardiography, noncontrast computed tomography for coronary artery calcium scoring, and blood testing, including high-sensitivity C-reactive protein. Additionally, SCORE2 or SCORE2-OP calculations will be performed, and the SF-12 quality-of-life questionnaire will be administered.

The study will include a total of 120 participants, with recruitment ending once 60 participants have been enrolled in each group. Each participant will be observed for one day, corresponding to the day-hospital visit. The planned recruitment period is 18 months.

Primary outcome measures

• Subendocardial viability ratio (SEVR) [Time frame: Once, during the day-hospital visit]

Secondary outcome measures (10)

• Carotid-femoral pulse wave velocity [Time frame: Once, during the day-hospital visit]
• Central pulsed pressure [Time frame: Once, during the day-hospital visit]
• Pulse pressure amplification [Time frame: Once, during the day-hospital visit]
• Augmentation index [Time frame: Once, during the day-hospital visit]
• Maximum exercise capacity [Time frame: Once, during the day-hospital visit]
• Left ventricular mass index [Time frame: Once, during the day-hospital visit]
• Coronary calcium score [Time frame: Once, during the day-hospital visit]
• High-sensitivity C-reactive protein [Time frame: Once, during the day-hospital visit]
• SCORE2 and SCORE2-OP [Time frame: Once, during the day-hospital visit]
• SF-12 quality-of-life scores [Time frame: Once, during the day-hospital visit]

Eligibility criteria

Inclusion criteria

• Male participant aged 18 years or older.
• Confirmed diagnosis of hypertension.
• Receiving pharmacological antihypertensive treatment.
• Consecutively admitted to the hypertension day-hospital unit for assessment of hypertension-mediated organ damage.
• No history of cardiovascular disease, particularly coronary artery disease, and asymptomatic for coronary artery disease.
• Affiliated with a French social security scheme.
• Having received the study information and not expressed opposition to participating.

Exclusion criteria

• Permanent atrial fibrillation
• Recurrent cardiac arrhythmias
• Not affiliated with a French social security scheme
• Opposition to participation

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Case-control

Study locations

France · 1 center

• Hôpital Lariboisière — Paris

Publications

• Tsiachris D, Tsioufis C, Syrseloudis D, Roussos D, Tatsis I, Dimitriadis K, Toutouzas K, Tsiamis E, Stefanadis C. Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses. J Hum Hypertens. 2012 Jan;26(1):64-70. doi: 10.1038/jhh.2010.127. Epub 2011 Jan 13. PMID 21228823
• Jackson G, Nehra A, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham G, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis JB, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FC. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. Int J Clin Pract. 2013 Nov;67(11):1163-72. doi: 10. PMID 23714173
• Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999 Dec;11(6):319-26. doi: 10.1038/sj.ijir.3900472. PMID 10637462
• Chiurlia E, D'Amico R, Ratti C, Granata AR, Romagnoli R, Modena MG. Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol. 2005 Oct 18;46(8):1503-6. doi: 10.1016/j.jacc.2005.06.068. Epub 2005 Sep 28. PMID 16226175
• Montorsi P, Ravagnani PM, Galli S, Rotatori F, Briganti A, Salonia A, Rigatti P, Montorsi F. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005 Dec 26;96(12B):19M-23M. doi: 10.1016/j.amjcard.2005.07.006. Epub 2005 Nov 4. PMID 16387561
• Vlachopoulos C, Ioakeimidis N, Stefanadis C. Biomarkers, erectile dysfunction, and cardiovascular risk prediction: the latest of an evolving concept. Asian J Androl. 2015 Jan-Feb;17(1):17-20. doi: 10.4103/1008-682X.143250. PMID 25412676
• Montorsi P, Ravagnani PM, Galli S, Salonia A, Briganti A, Werba JP, Montorsi F. Association between erectile dysfunction and coronary artery disease: Matching the right target with the right test in the right patient. Eur Urol. 2006 Oct;50(4):721-31. doi: 10.1016/j.eururo.2006.07.015. Epub 2006 Jul 28. PMID 16901623
• Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FC. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012 Aug;87(8):766-78. doi: 10 PMID 22862865

Identifiers

NCT: NCT07719790 · APHP251912 · IDRCB : 2026-A00520-51

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗