Background: Left ventricular assist device (LVAD) therapy is associated with improved survival and quality of life (QoL) in advanced heart failure (HF) patients either as bridge to heart transplant (BTT) or as destination therapy. Sexual dysfunction is common among HF patients and considered an important hamper to QoL. The aim of the current study was the evaluation of prevalence of erectile dysfunction (ED) in LVAD recipients and its association with QoL and depression.
Methods: This is a prospective, single-center, cross-sectional study. We included adult male patients on LVAD support who were clinically stable after at least 3 months post-implantation. Erectile function was assessed with the International Index of Erectile Function (IIEF-5) questionnaire with a score of ≤ 21 being confirmatory for ED. QoL and depression were estimated with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Patient Health Questionnaire depression scale (PHQ-8), respectively. Association between binary variables was estimated by the x2 test. Pearson's correlation was run to assess the relationship between IIEF-5, KCCQ, and PHQ-8 scores.
Results: We included 52 patients on continuous-flow LVAD. Mean age was 57 years and BTT was the therapeutic goal in 79% of patients. Median time on device support was 707 days. HeartMate III was the most common device type (69%) followed by HeartWare (31%). According to the IIEF-5 assessment, 78% of all study patients had ED. Mean IIEF-5 score was 11.9 ± 8.8, KCCQ 79.7 ± 5.5 % and PHQ-8 score 6.3 ± 5.7. There was no significant association between ED and common comorbidities (chronic kidney disease, diabetes, peripheral arterial disease, coronary artery disease, arterial hypertension, atrial fibrillation, chronic lung disease, and stroke). ED was not associated with the intake of beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, sacubitril/valsartan, aldosterone antagonists, sodium-glucose co-transporter 2 inhibitors, or phosphodiesterase-5 inhibitors (PDE5i). There was a statistically significant negative correlation between IIEF-5 score and depression symptom severity scale (r = -0.44, p < 0.014) while no significant correlation between IIEF-5 and KCCQ score was observed (r = 0.19, p = 0.25).
Conclusion: ED is highly prevalent among LVAD recipients and is associated with the severity of depressive symptoms. There is no association of ED with HF drugs and major comorbidities and PDE5i use is not associated with the prevalence of ED in this cohort.