Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

A new proof for the relationship between erectile dysfunction and atherosclerosis: fragmented QRS?


In patients with coronary artery disease (CAD), fragmented QRS (fQRS) is a practical marker of myocardial ischemia evaluated on electrocardiography (ECG).The current study investigated the connection between FQRS and erectile dysfunction (ED), which is commonly accepted as an early sign and independent predictor of CAD. The study consisted of a 190 ED patients; 47 of them having severe, 44 moderate, 49 mild-to-moderate, and 50 mild ED, and a control group of 51 otherwise healthy adult men. None of the participants had a history of cardiac disease. There was a significant difference among the groups in terms of fQRS; severe, moderate, and mild-to-moderate ED groups had significantly higher rates of fQRS presence on ECG (27.5%, 23.5%, and 22.5%, respectively) in comparison with those of mild ED and the control groups (13.7% and 12.7%, respectively) (p < 0.001). In patients presenting with ED complaints, a fQRS finding on a simple ECG recording may serve as a first sign of the presence of CAD. As far as we know, the present study is the first in the literature assessing the possible relationship between ED and fQRS. On the ECG, the existence of fQRS was considered to be connected with ED; thus, including this basic parameter into the clinical decisions for ED patients may initiate an extensive diagnostic approach for their underlying cardiovascular diseases.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others


  1. Porst H, Burnett A, Brock G, Ghanem H, Giuliano F, Glina S, et al. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med. 2013;10:130–71.

    Article  CAS  Google Scholar 

  2. NIH Consensus Conference. Impotence. NIH consensus development panel on impotence. JAMA. 1993;270:83–90.

  3. Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120:151–7.

    Article  Google Scholar 

  4. Raheem OA, Su JJ, Wilson JR, Hsieh TC. The association of erectile dysfunction and cardiovascular disease: a systematic critical review. Am J Mens Health. 2017;11:552–63.

    Article  Google Scholar 

  5. Yao F, Huang Y, Zhang Y, Dong Y, Ma H, Deng C, et al. Subclinical endothelial dysfunction and low-grade inflammation play roles in the development of erectile dysfunction in young men with low risk of coronary heart disease. Int J Androl. 2012;35:653–9.

    Article  CAS  Google Scholar 

  6. Montorsi F, Briganti A, Salonia A, Rigatti P, Margonato A, Macchi A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003;44:360–4.

    Article  Google Scholar 

  7. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006;27:2632–9.

    Article  Google Scholar 

  8. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Briganti A, Salonia A, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005;96:19–23.

    Article  Google Scholar 

  9. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113:2495–501.

    Article  Google Scholar 

  10. Korkmaz A, Yildiz A, Demir M, Ozyazgan B, Sahan E, Acar B, et al. The relationship between fragmented QRS and functional significance of coronary lesions. J Electrocardiol. 2017;50:282–6.

    Article  Google Scholar 

  11. Das MK, Michael MA, Suradi H, Peng J, Sinha A, Shen C, et al. Usefulness of fragmented QRS on a 12-lead electrocardiogram in acute coronary syndrome for predicting mortality. Am J Cardiol. 2009;104:1631–7.

    Article  Google Scholar 

  12. Femenía F, Arce M, Van Grieken J, Trucco E, Mont L, Abello M, et al. Fragmented QRS as a predictor of arrhythmic events in patients with hypertrophic obstructive cardiomyopathy. J Inter Card Electro. 2013;38:159–65.

    Article  Google Scholar 

  13. Cetin MS, Ozcan Cetin EH, Cay S, Topaloglu S, Temizhan A, et al. Usefulness of fragmented QRS complex to predict arrhythmic events and cardiovascular mortality in patients with noncompaction cardiomyopathy. Am J Cardiol. 2016;117:1516–23.

    Article  Google Scholar 

  14. Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart Rhythm. 2009;6:8–14.

    Article  Google Scholar 

  15. Michael M, Das M. Fragmented QRS (fQRS) on 12-lead ECG is a predictor of arrhythmic events and mortality in patients with dilated cardiomyopathy. Heart Rhythm. 2006;3:103.

    Article  Google Scholar 

  16. Mahentrihan J, Khan BR, Sawada SG, Das MK. Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. J Nucl Cardiol. 2007;14:347–53.

    Article  Google Scholar 

  17. Chatterjee S, Changawala N. Fragmented QRS Complex: a novel marker of cardiovascular disease. Clin Cardiol. 2010;33:68–71.

    Article  Google Scholar 

  18. Rosen RC1, Riley A, Wagner G. The international index of erectile function [IIEF]: a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–30.

    Article  CAS  Google Scholar 

  19. Ponholzer A, Temml C, Obermayr R, Wehrberger C, Madersbacher S. Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke? Eur Urol. 2005;48:512.

    Article  Google Scholar 

  20. Inman BA, Sauver JL, Jacobson DJ, McGree ME, Nehra A, Lieber MM, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84:108–13.

    Article  Google Scholar 

  21. Feldman DI, Cainzos-Achirica M, Billups KL, DeFilippis AP, Chitaley K, Greenland P, et al. Subclinical vasculardisease and subsequent erectile dysfunction: the multiethnic study of atherosclerosis (MESA). Clin Cardiol. 2016;39:291–8.

  22. Karabakan M, Bozkurt A, Gunay M, Aktas BK, Hirik E, Aydın M, et al. Association between serum fetuin-A level and erectile function. Andrologia 2016;48:787–92.

    Article  CAS  Google Scholar 

  23. Karabakan M, Bozkurt A, Akdemir S, Gunay M, Keskin E. Significance of serum endothelial cell specific molecule-1 (Endocan) level in patients with erectile dysfunction: a pilot study. Int J Impot Res. 2017;29:175–8.

    Article  CAS  Google Scholar 

  24. Çalışkan B, Korkmaz AN, Erdem F. Contribution of fragmented QRS on myocardial perfusion imaging in the assessment of functionally significant coronary artery stenoses. Eur Rev Med Pharm Sci. 2016;20:1575–81.

    Google Scholar 

  25. Zhang R, Chen S, Zhao Q, SUN M, YU B, HOU J. Fragmented QRS complex is a prognostic marker of microvascular reperfusion and changes in LV function occur in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Exp Ther Med. 2017;13:3231–8.

    Article  CAS  Google Scholar 

  26. Uslu N, Gul M, Cakmak HA, Atam A, Pusuroglu H, Satilmisoglu H, et al. The assessment of relationship between fragmented Qrs complex and left ventricular wall motion score index in patients with ST elevation myocardial infarction who underwent primary percuta¬neous coronary intervention. Ann Noninvasive Electro. 2015;20:148.

    Article  Google Scholar 

  27. Yang H, Pu M, Rodriguez D, Underwood D, Griffin BP, Kalahasti V, et al. Ischemic and viable myocardium in patients with non Q wave or Q wave myocardial infarction and left ventricular dysfunction: a clinical study using positron emission tomography, echocardiography, and electrocardiography. J Am Coll Cardiol. 2004;43:592.

    Article  Google Scholar 

  28. Park SJ, On YK, Kim JS, Park SW, Yang JH, Jun TG, et al. Relation of fragmented QRS complex to right ventricular fibrosis detected by late gadolinium enhancement cardiac magnetic resonance in adults with repaired tetralogy of fallot. Am J Cardiol. 2012;109:110–5.

    Article  Google Scholar 

  29. Bekar L, Katar M, Yetim M, Çelik O, Kilci H, Önalan O. Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Turk Kardiyol Dern Ars. 2016;44:554–60.

    PubMed  Google Scholar 

  30. Eyuboglu M, Ekinci MA, Karakoyun S, Kucuk U, Senarslan O, Akdeniz B. Fragmented QRS for risk stratification in patients undergoing first diagnostic coronary angiography. Arq Bras Cardiol. 2016;107:299–304.

    PubMed  PubMed Central  Google Scholar 

  31. Terho HK, Tikkanen JT, Junttila JM, Anttonen O, Kenttä TV, Aro AL, et al. Prevalence and prognostic significance of fragmented QRS complex in middle-aged subjects with and without clinical or electrocardiographic evidence of cardiac disease. Am J Cardiol. 2014;114:141–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mehmet Karabakan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

For this study we have received the local ethics committee approval.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

For this study we have received the local ethics committee approval.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karabakan, M., Bozkurt, A., Saylam, B. et al. A new proof for the relationship between erectile dysfunction and atherosclerosis: fragmented QRS?. Int J Impot Res 32, 302–307 (2020).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links