Utilidad del pliegue diagonal del lóbulo de la oreja en enfermedad coronaria, un signo simple y eficaz

Abstract

Different publications have pointed out the predictive value of the presence of the diagonal earlobe crease (DELC) for coronary artery disease (CAD) irrespective of gender, although its usefulness in patients over 60 years has been discussed. Despite the simplicity of its evaluation, it is not commonly used in clinical/forensic practice. METHODS: Systematic evaluation of the presence of DELC in forensic autopsies. RESULTS: 247 cases with 177 men (72%), mean age 64±16.3 years, violent death in 85 cases (34%), natural in 158 cases (64%) and undetermined in 4 cases (2%), 17% DM, 33% hypertension, 41% severe CAD, 51% sudden cardiovascular death (SCD-CV) and 26% sudden death due to ischemic heart disease (SCD-I). The presence of severe CAD was significantly associated with men, age ≥60 years, hypertension, increased heart weight and DELC; in multivariate analyses, only DELC and increased heart weight maintained their association with severe CAD. The same multivariate analyses were performed to predict SCD-CV and SCD-I. In the first case, only the male sex, increased heart weight and DELC, and in the second case only the male sex, hypertension and increased heart weight maintained statistical significance. Finally, we separately analyzed the age groups <60 years (N=91) and ≥60 years (N=156), estimating the utility of the DELC with Sensitivity=39 and 56%, Specificity=88 and 75%, Positive predictive value= 53 and 70%, Negative predictive value=81 and 62% respectively. CONCLUSIONS: Checking for the presence of PDL is easy, fast and cheap. Its strong and consistent independent association with severe CAD and CV death should position this trait as an important finding in the physical examination of patients with suspected CAD. In our series, this association was repeated in the group >60 years, although with less weight than in young people.