الفهرس 
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Abstract
Erectile dysfunction is defined as the inability to initiate or
maintain an erection long enough to have a satisfying sexual
relationship. Erectile dysfunction (ED) is the most common sexual
dysfunction in males, affecting 15% of men in their 40s and 50s, 45
percent of men in their 60s, and 70% of men over the age of 70.
Despite the fact that ED is a multifaceted process, vascular
insufficiency is a common cause, accounting for up to 80% of cases.
Many researches have shown that CVD risk factors such as diabetes
mellitus (DM), hypertension, old age, insulin resistance, smoking,
high body mass index (BMI), increased cholesterol, and low-density
lipoprotein (LDL) levels are also risk factors for erectile dysfunction.
In addition to the fact that ED is linked to a number of
cardiovascular risk factors in men, it is increasingly considered an
early sign of atherosclerosis and CVD.
According to studies, ED symptoms appear 2–3 years before
clinically significant coronary artery disease and 3–5 years before
cardiovascular events, implying that ED can be considered a new
cardiovascular risk factor and an individual predictor of
cardiovascular events.
The size of the artery hypothesis explains the association
between ED and CAD, implying that atherosclerosis damages small
vessels more than bigger vessels, and that when atherosclerosis affects
the coronary circulation, the damage to the penile artery is greater.
Pharmaco-penile duplex ultrasonography is an effective,
minimally invasive approach for individuals with erectile dysfunction
who have failed to respond to oral erectogenic medications (ED). In a
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variety of different disorders, such as Peyronie’s disease, priapism,
penile fracture, or masses involving deep tissues of the penis, PPDU is
used to offer an anatomic and functional vascular assessment.
PPDU is used as part of the ED evaluation to determine the
quality of arterial blood flow and the sufficiency of veno-occlusive
mechanisms, both of which are required for a good erection. Recently,
this imaging technique has become increasingly useful in the early
detection of otherwise silent coronary artery disease (CAD) in men
who present with ED as their initial symptom.
The most common procedure for diagnosing heart abnormalities
is electrocardiography (ECG). Over the last two centuries, the
electrocardiogram (ECG) has evolved in both technology and clinical
utility.
In patients with coronary artery disease, a fragmented QRS is a
reliable ECG sign of myocardial ischemia. As a new, useful, and
reliable ECG finding, fragmented QRS (fQRS) has sparked a lot of
interest.
It was defined as the presence of notched R or S waves in the
original QRS complex that aren’t followed by a typical branch block
or extra spikes akin to the RSR model 120 ms.
They believed it as a useful indicator in determining prognosis
for patients with CAD. It was discovered to be linked to underlying
structural cardiac problems, as well as a poor prognosis. Researchers
have linked the presence of fQRS to sudden cardiac death and the
recurrence of cardiac disorders.
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The aim of this study was to detect a fragmented QRS on an
ECG could be a better and earlier indicator of cardiovascular
involvement in patients with arteriogenic ED than PPDU.
Our study was conducted in the period from 2019 to 2021, cases
were obtained from andrology clinic of Menoufiya university hospital.
During this study, 100 cases were studied. Their ages ranged from 41
to 66 years old.
All cases were subjected to the following:
1. Detailed history taking.
2. Thorough clinical examination.
3. Imaging studies including PPDU and ECG for detecting
fragmented QRS.
Cases were classified according to IEEF to mild group (25
cases), mild to moderate group (35 cases), moderate group (25 cases)
and sever group (15 cases).
There was a significant difference between studied groups
regarding PPDU results as 46.7% of cases with severe and 44% of
cases with moderate erectile dysfunction had arteriogenic ED. While
only 28.6% of mild to moderate had arteriogenic ED and 20% of mild
cases had arteriogenic ED.
The presence of fragmented QRS was significantly different
among the studied groups as 66.7% of patients with severe and 60%
of patients with moderate erectile dysfunction had fragmented QRS
while 28.6% of patients with mild - moderate and 24% of patients
with mild erectile dysfunction had fragmented QRS.
There was significant relation between dopplex results of cases
regarding the presence of fragmented QRS as 56.1% of cases with
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fragmented QRS had arteiogenic dopplex. While only 22% with
fragmented QRS had venogenic and only 22% with fragmented QRS
had normal results.
Fragmented QRS was more specific 83% than sensitive 56%
with accuracy of 72% in arteriogenic ED prediction.