Relation of Diagonal Ear Lobe Crease to the Presence, Extent, and Severity of Coronary Artery Disease Determined by Coronary Computed Tomography Angiography

Shmilovich, Haim; Cheng, Victor; Rajani, Ronak; Dey, Damini; Tamarappoo, Balaji; Nakazato, Ryo; Smith, Thomas W.; Otaki, Yuka; Nakanishi, Rine; Gransar, Heidi; Paz, William; Pimentel, Raymond; Hayes, Sean W.; Friedman, John D.; Thomson, Louise; Berman, Daniel S.

doi:10.1016/j.amjcard.2011.12.024

Cited by 75 publications

(87 citation statements)

References 22 publications

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“…23 Recently we have also shown that DELC predicts the presence, extent, and severity of CAD. 9 Despite these confirmatory studies, there have also been other studies that have not demonstrated an association between CAD and DELC. 6,7 In the present study we showed that for unselected patients undergoing coronary CTA, DF outperformed DELC in terms of specificity (DF vs DELC: 63% vs 32%) and overall accuracy (DF vs DELC: 61% vs 42%), whereas DELC outperformed DF in terms of sensitivity (DELC vs DF: 90% vs 48%) and negative predictive value (DELC vs DF: 94% vs 86%).…”

Section: Discussionmentioning

confidence: 96%

“…4e8 Despite this, there is now emerging evidence that this simple clinical sign may be related to the presence, extent, and severity of CAD. 9 The aim of the present study was therefore to evaluate whether the addition of a DELC finding to the standard DF algorithm (DF þ DELC) enhances its predictive ability in detecting CAD50 as determined by coronary computed tomography angiography (CTA). …”

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confidence: 99%

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Incremental Value of Diagonal Earlobe Crease to the Diamond-Forrester Classification in Estimating the Probability of Significant Coronary Artery Disease Determined by Computed Tomographic Angiography

Shmilovich

Cheng

Nakazato

et al. 2014

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 96%

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confidence: 99%

Incremental Value of Diagonal Earlobe Crease to the Diamond-Forrester Classification in Estimating the Probability of Significant Coronary Artery Disease Determined by Computed Tomographic Angiography

Shmilovich

Cheng

Nakazato

et al. 2014

The American Journal of Cardiology

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“…In another study done in California, 430 patients were assessed for association between DELC and CAD using coronary computed tomography angiography. DELC was found in 71% of patients with CAD, concluding the importance of earlobe crease as an independent marker predicting the prevalence, extent, and severity of CAD [11]. In proposition, a review article discussed the benefit of DELC as a valuable marker for atherosclerotic risk assessment [12].…”

Section: Discussionmentioning

confidence: 99%

Diagonal Earlobe Crease as a Significant Marker for Coronary Artery Disease: A Case-control Study

Kamal¹,

Kausar²,

Qavi³

et al. 2017

Cureus

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Objectives:To investigate the association between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Limited data exists in South Asia and no prior studies have been performed in Pakistan to assess this relationship.Methods:In this case-control study, 200 participants from December 2015 to March 2016 at Shifa International Hospital, Islamabad, Pakistan were enrolled. Consecutive non-probability sampling was used to recruit patients. Cases were enrolled from cardiac care unit (CCU) of the hospital with angiography-proven CAD. Controls were selected from surgical, medical and neurology units of the hospital if they had no previously established evidence or symptoms of CAD. Patients were evaluated in terms of age and any history of hypertension, diabetes and/or smoking. Cases and controls were examined separately by two investigators for the unilateral or bilateral presence of DELC of the lobular portion of either auricle. Patients with ear piercings were excluded from the study. The data was analyzed in statistical product and service solutions (SPSS) (IBM, Delaware, Chicago), and an online statistical software.Results:Out of the 200 patients, 126 (63%) were males and 74 (37%) were females. In the 100 cases, 76 had DELC and 24 had no crease whereas, among the 100 controls, 36 had DELC and 64 had no DELC (p <0.001, OR = 5.63, CI = 2.91-10.93). The prevalence of diseases such as hypertension, diabetes, smoking among the cases and controls were 66%, 53%, 27% and 27%, 18%, 25% respectively. The effect of hypertension and diabetes on the presence of DELC was statistically significant (p <0.05) but the impact of smoking on DELC presence was insignificant (p >0.05).Conclusion:There is a significant association between DELC and CAD. This is the first case-control study from South Asia disclosing this important correlation. Our study also reports a high frequency of DELC in patients suffering from hypertension and diabetes mellitus. No association between smoking and DELC was found.

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“…2,3 DELC is also associated with higher risk of major adverse cardiac events in patients with known CAD. 4 Recent studies have suggested that DELC may also be a marker of generalized atherosclerotic disease.…”

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confidence: 99%

“…1 Since its first description, others have shown it to be associated with the presence, as well as the extent and severity, of CAD, independent of traditional CAD risk factors, such as serum lipids, diabetes mellitus, and smoking status. 2,3 DELC is also associated with higher risk of major adverse cardiac events in patients with known CAD. 4 Recent studies have suggested that DELC may also be a marker of generalized atherosclerotic disease.…”

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Bilateral Earlobe Creases and Coronary Artery Disease

et al. 2014

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A 73-year-old man with a history of hypertension and a family history of coronary artery disease (CAD) was seen in an outpatient clinic for stable angina. Physical examination showed bilateral earlobe creases, known as Frank's sign (Figure 1), and no other relevant cardiac findings.ECG showed normal sinus rhythm with no signs of ischemia. He was evaluated with a nuclear stress test, which revealed moderate reversible perfusion defects localized to the lateral wall. He underwent an elective coronary arteriography, which showed 80% stenosis of the left main coronary artery, 90% stenosis of the distal right coronary artery, and 90% stenosis of the proximal left circumflex coronary artery ( Figure 2). Left ventriculogram showed an ejection fraction of 60% with mild inferoapical and moderate inferobasal hypokinesis. The patient underwent 3-vessel coronary artery bypass graft surgery and has since done well.Diagonal earlobe crease (DELC), also known as Frank's sign, was first associated with CAD by Sanders T. Frank in 1973.1 Since its first description, others have shown it to be associated with the presence, as well as the extent and severity, of CAD, independent of traditional CAD risk factors, such as serum lipids, diabetes mellitus, and smoking status. 2,3 DELC is also associated with higher risk of major adverse cardiac events in patients with known CAD. 4 Recent studies have suggested that DELC may also be a marker of generalized atherosclerotic disease. DELC is associated with carotid-intima media thickness, a marker of subclinical atherosclerosis in subjects free of clinical cardiovascular disease, 5 and was reported recently to be associated with ischemic stroke. 6The etiologic basis of DELC in atherosclerotic disease is not fully understood. DELC may occur because of age-related or microvascular disease-associated weakening of elastic fibers in the ear lobes, reflecting a similar pathology in weakened coronary arteries. 7Our patient demonstrated bilateral ear lobe creases in the setting of severe CAD. Broader recognition among clinicians of this easily detectable sign may facilitate early diagnoses in patients at high risk for CAD. DisclosuresNone.

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Relation of Diagonal Ear Lobe Crease to the Presence, Extent, and Severity of Coronary Artery Disease Determined by Coronary Computed Tomography Angiography

Cited by 75 publications

References 22 publications

Incremental Value of Diagonal Earlobe Crease to the Diamond-Forrester Classification in Estimating the Probability of Significant Coronary Artery Disease Determined by Computed Tomographic Angiography

Incremental Value of Diagonal Earlobe Crease to the Diamond-Forrester Classification in Estimating the Probability of Significant Coronary Artery Disease Determined by Computed Tomographic Angiography

Diagonal Earlobe Crease as a Significant Marker for Coronary Artery Disease: A Case-control Study

Bilateral Earlobe Creases and Coronary Artery Disease

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