Penile Doppler Ultrasound Systolic Impairment Predicts Major Cardiovascular Events in poor responders to PDE5-i Therapy

<title>Abstract</title> <p> <bold>Purpose:</bold> To evaluate the association between penile color Doppler duplex ultrasound (CDDU) parameters and cardiovascular risk (CVR), and whether impaired penile hemodynamics predict future cardiovascular events in men with erectile dysfunction (ED) refractory to phosphodiesterase type 5 inhibitors (PDE5-i). <bold>Materials and Methods:</bold> A total of 285 men who underwent penile CDDU for ED were retrospectively analyzed. Inclusion criteria: age 40–79 years, confirmed ED, inadequate response to ≥ 90 days of PDE5-i therapy. The Charlson Comorbidity Score (CCI) and the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score were calculated. Peak systolic velocity (PSV) and resistive index (RI) were measured at 5 and 20 minutes after intracavernosal injection of prostaglandin E₁. Arteriogenic ED was defined as PSV &lt; 30 cm/s, and veno-occlusive dysfunction as RI &lt; 0.80. <bold>Results:</bold> The median age was 61 years (IQR 55–67). Patients with impaired PSV were older, had higher systolic blood pressure and comorbidity scores. The CCI and the ASCVD 10-year risk score were independent predictors of PSV impairment in univariate linear regression (respectively index β= -1.94, p &lt; 0.01; index β=-0.37, p &lt; 0.01). The multivariate logistic model showed an association between the ASCVD score and the PSV reduction (OR 1.19, 95% CI 1.07–1.32; p &lt; 0.01). No significant associations were observed between RI and systemic CVR factors. Patients with impaired PSV experienced a significantly higher incidence of major cardiovascular events during a median follow-up of 53 months compared with those with normal PSV (11.8% vs 3.2%, p = 0.02). <bold>Conclusions:</bold> Impaired PSV at penile CDDU is independently associated with higher ASCVD risk and predicts future cardiovascular events in poor responders to PDE5-i. An accurate penile CDDU study might represent a valuable non -invasive tool for CVR stratification and early implementation of prevention strategies in this population. </p>