The prognostic value of the Frank sign

J Prangenberg,L Johann,E Doberentz,B Madea

doi:10.1007/s12024-022-00463-8

J Prangenberg, L Johann + Show 2 more

Open Access

https://doi.org/10.1007/s12024-022-00463-8

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Abstract

Frank’s sign (named after American pulmonologist Sanders T. Frank) refers to a diagonal skin fold between the tragus and outer edge of the earlobe. Gradation is based on the bilateral presence and/or degree of the earlobe fold. The presence of this sign, referred to as the diagonal earlobe crease (DELC), has been associated with coronary artery disease (CAD), independent of other cardiovascular risk factors. Corresponding studies are predominantly based on clinical or angiographic assessments, and few autopsy studies exist. The association of DELC with CAD, cardiovascular risk factors, and causes of death was investigated via retrospective and prospective evaluations. It was also investigated whether the degree of DELC correlated with the macroscopic severity of coronary heart disease. Furthermore, the influence of age on the appearance of DELC was analyzed and compared using two age groups. Additionally, binomial logistic regression analysis was performed to investigate the influence of age on the presence of higher-grade DELC and CAD. In cases related to a lethal cardiac event, the majority (78%) showed high-grade DELC. The DELC grade correlated significantly with CAD severity (rs = 0.474, p < 0.001) and with the severity of general atherosclerosis (rs = 0.606, p < 0.001) with medium and large effects sizes, respectively. Age was predominantly more suitable than DELC concerning the sensitivity, specificity, and positive prognostic value for preexisting cardiac disease and cardiac-related causes of death. In both DELC and CAD, age has a significant influence on the presence of higher-grade manifestation, but the influence of age in CAD appears to be even more significant than in DELC. The main results of previous autopsy studies and the prognostic value could have been confirmed, but these findings appear to be limited to younger patients.

Highlights

The Frank sign was first established in 1973 by American pulmonologist Sanders T
To determine the prognostic value of Frank’s sign, we divided the collective into two groups with either low grade or high grade diagonal earlobe crease (DELC) and carried out Student’s t-tests for two independent
DELC grade correlated significantly with coronary artery disease (CAD) severity and with the severity of general atherosclerosis. In both DELC and CAD, age has a significant influence on the presence of higher-grade manifestation, but the influence of age in CAD appears to be even more significant than in DELC

Summary

Introduction

The Frank sign was first established in 1973 by American pulmonologist Sanders T. Frank to describe a unilateral or bilateral diagonal fold of skin between the tragus and outer edge of the earlobe, which is called a diagonal earlobe crease (DELC) [1]. Gradation may be based on the bilateral occurrence and/or degree of the earlobe crease (Fig. 1). Since its first description by Frank, various studies have confirmed the association between a DELC and coronary heart disease [6,7,8,9,10,11,12] as well as an association with increased cardiac morbidity and mortality [13]. The associations between the degree of Frank’s sign with cardiovascular diseases and cardiac-related causes of death in the context of forensic autopsies were investigated, and their prognostic values were compared based on the age of the deceased

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