ÖZET

Amaç:

Bu çalışmada erektil disfonksiyonlu (ED) hastalarda treadmill egzersiz testi parametrelerini incelemeyi amaçladık.

Yöntemler:

Kardiyoloji polikliniğine başvuran 178 hastaya Uluslararası Erektil İşlev Formu-5 (UAEİF-5) doldurtuldu. Sonuçlara göre hastalar iki gruba ayrıldı. Hastaların egzersiz zamanı, maksimum kalp hızı (KH), istirahat KH, kronotropik indeksi (Kİ), birinci ve ikinci dakikadaki KH toparlanma indeksleri (KHTİ 1 ve KHTİ 2) hesaplandı.

Bulgular:

ED’si olan hastalar daha yaşlı idi, diyabet ve hipertansiyon açısından her iki grup arasında fark gözlenmedi. Egzersiz zamanı ED’li hastalarda kontrol grubuna göre daha uzundu ve maksimum KH daha yüksekti [556,00 (61) dk ile 575,5 (84) dk p=0,025 ve 156,00 (13) vuru/dk ile 160,50 (11) vuru/dk p=0,001]. İstirahat KH, KHTİ 1, KHTİ 2 ve Kİ açısından gruplar arasında fark saptanmadı. UAEİF-5 skoru yaş (r=-0,54, p=<0,001), total kolesterol (r=-0,32, p=<0,001), LDL-K (r=-0,34, p=<0,001) ve TG (r=-0,17, p=0,02) ile pozitif, egzersiz süresi (r=0,19, p=0,01) ve maksimum KH (r=0,24, p=0,001) ile negatif korrelasyon gösterdi. Anormal KHTİ 1 değerleri çalışma grubunda kontrol grubuna göre anlamlı olarak yüksek bulundu (sırası ile, n=29, %23,6 ile n=6, %10,9, p=0,04). Quade ANCOVA sonuçlarına göre yaş kovaryant olarak alındığında egzersiz zamanı ve maksimum KH iki grup arasında farklı bulunmadı (sırası ile, F=1,032 p=0,311 and F=1,264, p=0,262).

Sonuç:

ED’li hastalarda anormal değerdeki KHTİ 1 daha fazla gözlenmektedir. Egzersiz treadmill testi bu hasta grubunda otonom aktiviteyi değerlendirmek için kullanılabilir.

References

Nicolosi A, Moreira ED Jr, Shirai M, Bin Mohd Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology 2003;61:201-6.

Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol 2014;65:968-78.

Pastuszak AW. Current Diagnosis and Management of Erectile Dysfunction. Curr Sex Health Rep 2014;6:164-76.

Krassioukov A, Elliott S. Neural Control and Physiology of Sexual Function: Effect of Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017;23:1-10.

Fisher JP. Autonomic control of the heart during exercise in humans: role of skeletal muscle afferents. Exp Physiol 2014;99:300-5.

Engeseth K, Hodnesdal C, Grundvold I, Liestøl K , Gjesdal K , Kjeldsen SE , et al. Temporal Reduction in Chronotropic Index Predicts Risk of Cardiovascular Death Among Healthy Middle-Aged Men: a 28-Year Follow-Up Study. J Am Heart Assoc 2016;5:e004555.

Brubaker PH, Kitzman DW. Chronotropic Incompetence: Causes, Consequences, and Management. Circulation 2011;123:1010-20.

Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 1994;24:1529-35.

Adabag AS, Grandits GA, Prineas RJ, Crow RS, Bloomfield HE, Neaton JD, et al. Relation of heart rate parameters during exercise test to sudden death and all-cause mortality in asymptomatic men. Am J Cardiol 2008;101:1437-43.

Turunç T, Deveci S, Güvel S, Peşkircioğlu S. The Assessment of Turkish Validation with 5 Question Version of International Index of Erectile Function (IIEF-5). Turkish Journal of Urology 2007;33:45-9.

Cole CR, Blackstone EH, Pashkow F, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 1999;341:1351-7.

Lauer MS, Mehta R, Pashkow FJ, Okin PM, Lee K, Marwick TH. Association of chronotropic incompetence with echocardiographic ischemia and prognosis. J Am Coll Cardiol 1998;32:1280-6.

Giuliano F, Rampin O. Neural control of erection. Physiol Behav 2004;83:189-201.

Antelmi I, Chuang EY, Grupi CJ, Latorre Mdo R, Mansur AJ. Heart rate recovery after treadmill electrocardiographic exercise stress test and 24-hour heart rate variability in healthy individuals. Arq Bras Cardiol 2008;90:380-5.

Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 2000;284:1392-8.

Kałka D, Domagała Z, Kowalewski P, Rusiecki L, Wojcieszczyk J, Kolęda P, et al. The influence of endurance training intensity on dynamics of post-exertional heart rate recovery adaptation in patients with ischemic heart disease. Adv Med Sci 2013;58:50-7.

Dogru MT, Basar MM, Haciislamoglu A. The Difference of Heart Rate Recovery between Males with and without Erectile Dysfunction. Ann Noninvasive Electrocardiol 2010;15:223-9.

Kałka D, Domagała Z, Rusiecki L, Karpiński L, Gebala J, Kolęda P, et al. Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease. Anatol J Cardiol 2016;16:256-63.

Ulucan S, Kaya Z, Keser A, Katlandur H, Karanfil M, Ates I. Deterioration of heart rate recovery index in patients with erectile dysfunction. Anatol J Cardiol 2016;16: 264-9.

Kucukdurmaz F, Acar G, Resim S. Deterioration of Chronotropic Responses and Heart Rate Recovery Indices in Men With Erectile Dysfunction. Sex Med 2018;6:8-14.

Ioakeimidis N, Samentzas A, Vlachopoulos C, Aggelis A, Stefanadis C, Tousoulis D. Chronotropic Incompetence and Dynamic Postexercise Autonomic Dysfunction Are Associated with the Presence and Severity of Erectile Dysfunction. Ann Noninvasive Electrocardiol 2016;21:256-62.

Fisher JP. Autonomic control of the heart during exercise in humans: role of skeletal muscle afferents. Exp Physiol 2014:99;300-5.

KannankerilPJ, Le FK, Kadish AH, Goldberger JJ. Parasympathetic effects on heart rate recovery after exercise. J Investig Med 2004;52:394-401.

Erektil Disfonksiyonlu Hastalarda Treadmill Stres Testi Parametrelerinin Değerlendirilmesi

ÖZET

References