الفهرس 
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Abstract
Erectile dysfunction and CAD share the common predisposing factors including DM. ED has been known to precede the event of CAD. In addition, SMI is more common at DM patients with being a strong predictor of cardiac events and death.Therefore, it is useful to identify clinical conditions associated with SMI that can be easily diagnosed like erectile function. So, our prospective study aimed to evaluate the relationship between SMI using the MDCT-CA and ED severity, and identify predictors of SMI in the same patients population.
We evaluated the ED patients with DM without any past or present history of cardiac symptoms. Initial evaluation including history taking and general examination were done. Laboratory investigations were done to evaluate glycemic control, cardiovascular risk factors, renal functions, and both lipid & hormonal profile. Erectile function was evaluated with three validated tools including sexual health inventory for men (SHIM) score, erection hardness score (EHS), and measurement of the maximal penile circumferential change (MPCC) by erectometer. MDCT-CA was used for the detection of coronary artery stenosis as a marker of SMI .
The study included 20 ED patients with DM (mean age 61.45± 10.7). 95% of patients were type 2 DM with DM duration 6 (1-20) years.
Associated co-morbidities were smoking (55%), hypertension (45%), and dyslipidemia (30%). Erectile function evaluation with SHIM score was 5 (2.5-8.5) with 75% had severe ED (≤7). The patients showed EHS 2(1-2) with 40% of the patients had EHS≤1. The measurement of the MPCC showed 14.5±9.46 with 64.3% of the patients have MPCC < 20mm.
MDCT-CA showed coronary artery stenosis in 13/20 (65%) with the one-vessel affection 6/20 (30%) was the commonest presentation. Indeed 50% of patients showed obstructive CAD (≥50% lumen obstruction). LAD coronary artery was the commonest CAD with stenosis (55%). Fifteen % (3/20) of patients had over 90% stenosis, and 2 of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age, and negatively correlated with EHS. Multivariate regression analysis using the age and EHS parameters showed that age is the only predictor for SMI.
In conclusion, CAD is highly prevalent (65%) in the diabetic ED patients in the outpatient’s clinic.“Age” was a single significant predictor for the coronary artery stenosis in diabetic ED patients. The MDCT-CA could be a useful non-invasive tool to identify SMI in DM patients with ED especially in those with advanced age and/or severe ED.