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CRT IMPROVES SEXUAL HEALTH OF MEN WITH CHRONIC HEART FAILURE

A new study published in the journal Clinical Cardiology1 reveals that in men with chronic heart failure, cardiac resynchronisation therapy (CRT) improves patients’ libido, erectile dysfunction, and sexual performance. Royal Brompton Hospital cardiologists comment on the paper to Arrhythmia Watch.

Led by Dr Ahmet Vural of Kocaeli University, researchers investigated the effects of CRT on libido and erectile dysfunction (ED) in 31 male patients with advanced chronic heart failure, scheduled for implantation of a CRT device. They were assessed before and six months after CRT.

At the six-month follow-up after CRT, 23 patients reported no ED, two patients had moderate ED, and severe dysfunction was not found in any patient. A significant increase in patients with normal libido was found, with 25 men reporting improvement compared to only three reporting normal libido prior to CRT.

The authors say that the apparent benefits of CRT for libido, ED, and sexual performance are a consequence of the improvement in functional capacity and ejection fraction.  “Not only does CRT decrease mortality in heart failure patients, it also brings improvement in sexual health to the patient’s life,” Vural concludes.

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Guha K, Sharma R. Editorial Response to Effect of Cardiac Resynchronisation Therapy on Libido and Erectile Dysfunction:

Cardiac resynchronisation therapy (CRT) is an established therapeutic option for selected patients with symptomatic left ventricular systolic dysfunction and a broad QRS complex. The cardiac benefits of CRT in this cohort are well documented with improvements in terms of both morbidity and mortality. Vural et al suggest a somewhat unexpected non-cardiac benefit from this therapy CRT.

Utilising a cohort undergoing CRT implantation, they demonstrate an improvement in erectile dysfunction and libido after six months. This was investigated using symptom score questionnaires and a validated classification system (SHIM index – Sexual Health Inventory for Men). Notably the cohort was younger (Mean Age= 54 +/- 8 ) as compared to patients enrolled in randomised controlled trials of CRT. The majority of patients had a dilated cardiomyopathy as an aetiology for their heart failure. Due to the limited number of patients, no meaningful analysis could be performed on sub groups with diabetes mellitus or hypertension.

There was a significant improvement in erectile dysfunction following CRT. Correspondingly, the symptom score questionnaire demonstrated an increase in libido and psychosocial well being. These findings correlated with reverse left ventricular remodelling (r = 0.47) and New York Heart Association (NYHA) symptomatic improvement (r = -0.36). The authors propose that CRT is responsible for these findings either via a haemodynamic mechanism or placebo effect. The usual limitations apply for such work within this area (small sample size, single centre, non randomised study). Furthermore, there was no adjustment of concomitant heart failure therapies following CRT.

From the data presented, it is difficult to draw definitive conclusions. It may well be the case that erectile dysfunction is a surrogate marker of generalised mental well being. This hypothesis is supported by the association between an improvement in NYHA functional class and libido and erectile dysfunction.

CRT has been shown to improve numerous cardiac parameters and surrogates including (but not exclusively) exercise tolerance, symptoms, left ventricular remodelling and mortality. The extra cardiac benefits are less well documented. The study is an interesting observation which, as stated by the authors, requires further work within this area. In particular, there should be a focus on elderly and ischaemic patients. It remains of interest to see whether such initial findings would be replicated in more representative cohorts undergoing CRT implantation.

Authors

Dr Kaushik Guha

Dept of Cardiology, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP

Dr Rakesh Sharma

Consultant Cardiologist

National Heart & Lung Institute, Imperial College London, Dovehouse Street, SW3 6LY

Corresponding Author:

Dr Kaushik Guha

Clinical Research Fellow in Cardiology

Division of Heart Failure, Department of Cardiology

Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

Email: k.guha@rbht.nhs.uk

Tel: +44 207 351 7716

Fax: +44 207 351 8148

References

1 Vural A, Agacdiken A, Celikyurt U, et al.  Effect of Cardiac Resynchronization Therapy on Libido and Erectile Dysfunction. Clin Cardiol 2011; DOI:10.1002/clc.20918.

Published on: July 6, 2011

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