Association Between Parameters of Penile Doppler Ultrasound and Cardiovascular Risk in Patients with Erectile Dysfunction: A Single-Center Retrospective Study

Andrea Graziani; Andrea Delbarba; Matteo Nardin; Nicola Caretta; Pierfrancesco Palego; Giuseppe Grande; Andrea Di Nisio; Carlo Cappelli; Alberto Ferlin

doi:10.3390/jcm15072722

Association Between Parameters of Penile Doppler Ultrasound and Cardiovascular Risk in Patients with Erectile Dysfunction: A Single-Center Retrospective Study

Graziani A, Delbarba A, Nardin M, Caretta N, Palego P, Grande G, Di Nisio A, Cappelli C, Ferlin A

Published April 3, 2026 Journal of clinical medicine

DOI 10.3390/jcm15072722 PMID 41977022 PMC PMC13073985

RRM Academy Synopsis

Penile Doppler flow is associated with estimated heart risk in ED

Lower blood flow in the penile arteries was associated with higher estimated cardiovascular risk before adjustment in men with erectile dysfunction (ED). The study was a retrospective review of 275 men at one Italian center. The association was no longer significant after adjusting for age and diabetes.

Key Findings

Of 275 men, 253 had a QRISK3 10-year cardiovascular risk score and entered the main analyses: 158 aged 60 years or younger and 95 older than 60.
Mean peak systolic velocity (PSV) was inversely correlated with QRISK3 (p < 0.01) and associated with a QRISK3 of 10% or higher in unadjusted logistic regression (β = −0.016, p = 0.048).
The association was no longer significant after adjusting for age and diabetes mellitus. Adding PSV to age and diabetes moved the area under the curve (AUC) from 0.966 to 0.968.
PSV alone had an AUC of 0.60 (95% CI 0.53–0.67) for higher risk. At 35 cm/s, specificity was 89% (95% CI 82.4–93.8%) and sensitivity 27% (95% CI 20.5–35.0%).
Men aged 60 or younger showed a significant association (β = −0.023, p = 0.041); older men did not (p = 0.51). The age interaction was significant (p = 0.006).

Interpretation

The study is a retrospective review at one tertiary referral clinic for men's reproductive health. It reports associations, and the authors note that the design does not allow definitive conclusions about cause. The men were referred for suspected vascular ED, and the authors caution that results may not generalize to men seen in primary care. The outcome was QRISK3, a calculated risk score driven strongly by age and diabetes. The authors state that the findings do not support PSV as a standalone cardiovascular screening tool, and they note that Doppler results depend on the operator.

RRM Context

Restorative reproductive medicine considers both partners and root causes, so a man's health belongs in the evaluation. The authors note that ED and cardiovascular disease share risk factors, and several of these are also risk factors for male factor infertility. They cite Italian guidelines that call for a holistic approach to men with ED. Vascular and metabolic health in the male partner fits a couple-level orientation.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Erectile dysfunction (ED) is increasingly recognized as an early manifestation of systemic vascular disease and might represent a window for cardiovascular risk assessment. Dynamic penile colour Doppler ultrasound (PCDU) provides quantitative arterial and venous parameters that could reflect subclinical vascular impairment. We investigated the association between PCDU parameters and estimated cardiovascular risk in men with ED.

Methods

In this single-center retrospective observational study, 275 men undergoing PCDU for ED were evaluated. Clinical characteristics, biochemical data, and QRISK3 10-year cardiovascular risk scores were collected. Mean peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were analyzed. Correlation analyses, logistic regression using a QRISK3 ≥ 10% threshold, linear regression models, age-stratified analyses, and receiver operating characteristic (ROC) curve analyses were performed.

Results

Patients with impaired PSV (<35 cm/s) were older and exhibited higher QRISK3 scores and a greater prevalence of diabetes mellitus and previous cardiovascular events. Mean PSV was inversely correlated with QRISK3 (r = -0.203, p < 0.01) and was associated with higher cardiovascular risk categories in unadjusted logistic regression (β = -0.016, p = 0.048), but not after adjustment for age and diabetes mellitus. ROC analysis showed modest discrimination of increased cardiovascular risk (AUC = 0.60). The addition of PSV to a model including age and diabetes resulted in minimal improvement in discrimination (AUC 0.966 vs. 0.968). Age-stratified analysis demonstrated a significant association between lower PSV and higher cardiovascular risk only in patients ≤60 years. A progressive increase in QRISK3 was observed according to the number of abnormal Doppler parameters (p = 0.013).

Conclusions

PCDU parameters reflect the overall cardiovascular risk burden in men with ED. Although not independent predictors beyond traditional risk factors, penile Doppler abnormalities might identify a vascular phenotype associated with higher estimated cardiovascular risk, particularly in younger individuals. These findings support the role of comprehensive vascular assessment in selected patients with ED.

Andrea Graziani, Andrea Delbarba, Matteo Nardin, Nicola Caretta, Pierfrancesco Palego, Giuseppe Grande, Andrea Di Nisio, Carlo Cappelli, Alberto Ferlin

A Graziani, A Delbarba, M Nardin, N Caretta, P Palego, G Grande, A Nisio, C Cappelli, A Ferlin

PMID 41977022 41977022 DOI 10.3390/jcm15072722 10.3390/jcm15072722 Graziani et al. 2026, Graziani 2026

Association Between Parameters of Penile Doppler Ultrasound and Cardiovascular Risk in Patients with Erectile Dysfunction: A Single-Center Retrospective Study

Penile Doppler flow is associated with estimated heart risk in ED

Key Findings

Interpretation

RRM Context

Abstract

By this author

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