Presence Of Diagonal Earlobe Crease Research Articles

Traditional Cardiovascular Risk Factors Associated with Diagonal Earlobe Crease (Frank Sign) in Mexican Adults: Aging, Obesity, Arterial Hypertension, and Being Male Are the Most Important.

Cardiovascular risk factors such as obesity, type 2 diabetes, hypertension, smoking, and dyslipidemia enfold heart disease morbimortality. Diagonal earlobe crease has been proposed as a prognostic marker of extension and severity of illness in patients with acute coronary syndrome. But its usefulness remains unclear in patients with or without coronary disease. A case-control study was carried out on a total of 805 patients with and without cardiovascular risk factors or acute coronary syndrome. Univariate and multivariate binary logistic regression analyses were used to determine the probability of having diagonal earlobe crease with the presence of cardiovascular risk factors and acute coronary syndrome. Data were summarized as odds ratio with 95% confidence intervals and P values. An unadjusted (univariate) analysis showed that being male, being older than 55 years, obesity, type 2 diabetes mellitus, arterial hypertension, smoking, and dyslipidemia, as well as having acute coronary syndrome, were associated with the presence of diagonal earlobe crease. The multivariate analysis showed that men (OR 1.6, 95% IC 1.1-2.4, P=0.007), being over 55 years old (OR 4.8, 95% IC 3.2-7.2, P < 0.001), being obese (OR 2.1, 95% IC 1.4-3.1, P < 0.001), having arterial hypertension (1.5, 95% IC 1.1-2.3, P=0.025), or suffering from acute coronary syndrome (OR 5.3, 95% IC 2.5-11.1, P < 0.001), were independent factors associated with diagonal earlobe crease. The rest of cardiovascular risk factors were not relevant in the multivariate model. In Mexican adults, having an acute coronary syndrome is not the only factor associated with diagonal earlobe crease but also being a man, older than 55 years, having high blood pressure and obesity. Diagonal earlobe crease may simply be caused by changes in the skin and connective tissues of the ears because of the aging process, obesity, and/or being male. These factors, by themselves, enfold cardiovascular risk due to well-known pathophysiological causes.

Relationship between diagonal earlobe crease (Frank's sign) and international index of erectile dysfunction score (IIEF-5)

The objective of this study is to examine the association between erectile dysfunction (ED) and the presence of diagonal earlobe crease (DELC), a physical sign commonly associated with atherosclerosis. A total of 96 male patients, aged between 50 and 65 years, were referred to our institute between December 2020 and March 2021 for various urological conditions. These patients were included in the study. Erectile performance was assessed using the IIEF-5 score, and DELC was visually identified by a urologist. The patients were administered the IIEF-5 questionnaire, and the results were categorized into two groups: the DELC group included patients with an earlobe crease, while non-DELC group consisted of patients with normal earlobes. In total, 96 patients participated in the study. We observed a decrease in IIEF-5 scores among patients in the DELC group compared to those in the non-DELC group. A statistically significant difference was found between the DELC group and the non-DELC group (p &lt; 0.01). This study demonstrates that the presence of an earlobe crease may serve as a predictive sign of atherogenic erectile dysfunction in male patients aged 50–65 years. Further investigations should be conducted to explore the utility of DELC as a standard indicator during the physical examination of erectile dysfunction.

Frank sign may predict more advanced coronary artery disease in patients admitted with a first time acute coronary syndrome

Aim: Diagonal ear lobe crease (DELC), also called as Frank's sign, is a diagonal fold or wrinkle-like line in the skin of the earlobe. This sign detected on the physical examination was proposed as a surrogate marker for individuals at high risk of cardiovascular disease. The aim of our study was to assess the relationship between presence of DELC and the severity of coronary artery disease according to the SYNTAX score in patients with firstly diagnosed acute coronary syndrome (ACS).&#x0D; Material and Methods: 356 patients admitted to the emergency department with the diagnosis of ACS from November 2015 to December 2016 were enrolled into the study. Patients were stratified into 3 groups: low SYNTAX score (&lt; 23), high SYNTAX score (≥23) and patients with normal coronary. &#x0D; Results: Patients with DELC as percentage were statistically significantly different between all groups (p &lt; 0.001). Higher number of DELC (OR = 0.497; 95% CI: 0.246-1.001; p = 0.043) was an independent predictor for a high SYNTAX score in the ACS patients after multiple linear regression analysis. &#x0D; Conclusion: Frank’s sign can help primary practitioners to predict severity of CAD.

Adropin and Irisin Deficiencies Are Associated With Presence of Diagonal Earlobe Crease in CAD Patients.

Background and Aims: Diagonal earlobe crease (ELC) has been considered a potential cutaneous marker of atherosclerosis. However, the potential mechanism by which ELC and atherosclerosis are linked has not been adequately defined. Roles of adropin and irisin, novel biomarkers of endothelial function, in ELC have not been well-studied. This study aimed to test whether individuals with ELC are deficient in adropin and irisin, a characteristic that would likely promote endothelial dysfunction and provide a plausible common pathological basis for atherosclerosis and ELC.Methods: Patients diagnosed with coronary artery disease (CAD) with (n = 45) and without (n = 45) ELC were consecutively enrolled in the study. The ages of the patients enrolled ranged from 40–70 years. Other patients (n = 45) without ELC or CAD were recruited as the control group. All patients underwent coronary angiography. Serum adropin and irisin concentrations were assessed via enzyme-linked immunosorbent assay.Results: Circulating levels of irisin in the ELC group were significantly lower than those in the non-ELC group, and were highest in the control group. Serum adropin levels of the ELC group were significantly lower than those of the non-ELC group (P < 0.001). Interestingly, although the serum adropin level of the control group was greater than that of the non-ELC group, the difference failed to achieve statistical significance. In subgroup analysis of CAD and ELC, both serum adropin and irisin levels of the CAD and ELC groups were lower than those of the control group (P < 0.001). Receiver-operating characteristic curve analysis revealed that adropin and irisin have similar prognostic power for CAD and ELC.Conclusions: Low adropin and irisin were significantly associated with CAD and ELC. The deficiencies in adropin and irisin may be a common cause of both atherosclerosis and ELC, which explains why patients with ELC are prone to CAD.

Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign

ObjectiveCardiovascular diseases are the most common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Literature indicates that there may be a relationship between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Accordingly, the present study aimed to assess the relationship with DELC and cardiac comorbidities in patients with COPD during routine physical examination. Materials and MethodsIn this prospective cohort study, we evaluated the demographic data, pulmonary function test (PFT) results, lipid profile, oxygen saturation, and the presence of DELC in patients with COPD and control subjects. ResultsDELC was diagnosed in 155 (62%) of COPD patients and these patients had a higher prevalence of CAD (p = 0.044). Moreover, DELC was diagnosed in 135 men (68.5%) and 20 (37.7%) women in the COPD group (p<0.001) and in 39 (48.8%) men and 14 (56.0%) women in the control group (p = 0.527). On the other hand, CAD was diagnosed in 18% of patients with early-stage COPD (n = 104) and in 30.8% of patients with late-stage COPD (n = 146) (p = 0.041). The sensitivity and specificity of DELC positivity in predicting CAD were 80.65% and 44.15% in COPD patients, respectively. ConclusionThe presence of cardiac comorbidities in COPD patients may play a vital role in the severity of the disease, exacerbations, and may also reduce the treatment response. Accordingly, an earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity.

Diagonal earlobe crease (Frank's sign) and increased risk of cerebrovascular diseases: review of the literature and implications for clinical practice.

Diagonal earlobe crease (DELC) or Frank's sign is a diagonal crease in the earlobe that extends diagonally from the tragus to the edge of the auricle with an angle of approximately 45°. Although its presence increases with advancing age, several studies have shown an independent association between DELC and cardiovascular diseases as well as peripheral vascular diseases. DELC has also been demonstrated to increase the risk of cerebrovascular events (mostly ischaemic stroke), probably through atherosclerotic mechanisms. A systematic literature search was conducted using PubMed and Embase to identify studies investigating the relationship between DELC and the occurrence of cerebrovascular diseases. We identified 5 articles (1469 subjects included). Since the presence of DELC can be easily evaluated, patients with the Frank's sign should undergo a diagnostic workup to detect vascular risk factors and implement preventative therapies.

Association of calcified carotid artery plaque in panoramic images and diagonal earlobe crease.

Brazilians who are free of traditional atherogenic risk factors frequently suffer myocardial infarctions (MI). Calcified carotid artery plaque (CCAP) on panoramic images (PIs) has been shown to be a validated "risk indicator" of future MIs. The diagonal earlobe crease (DELC) is likewise a validated "risk indicator" of future MI. We sought to determine the prevalence of DELC+ among patients having CCAP+ on their PIs. In a masked cross-sectional study, three dentists evaluated PIs of patients (N = 481) over age 55 for presence of CCAP+. Among the CCAP+ cohort, the presence of DELC+ was determined by two additional dentists masked to the presence of CCAP+ on PIs. A control group (CCAP-) comprised of individuals with PIs devoid of plaque was similarly evaluated for evidence of DELC+. A mixed-gender group (8.6%) of patients (N = 41; mean age 67.5 ± 6.8) evidenced CCAP+ on their PIs and approximately 88% of these individuals (N = 36) had concomitant DELC+. Among members of the control group (N = 41), 17 patients were DELC+. Our results demonstrated that among the full mixed-gender cohort (N = 82), the association between CCAP+ and DELC+ was statistically significant (p = 0.0001). However, when adjusting for gender, only the CCAP+ men were significantly (p = 0.00011) more likely to evidence DELC+ on clinical examination. Males with atherosclerosis of their carotid arteries as evidenced by PIs displaying calcified atheromas are significantly more likely to evidence a DELC+ than those without an imaged atheroma.

Diagonal ear lobe crease: A premonitory diagnostic sign of impeding ischemic heart disease.

Introduction:In India, significant number of individuals suffers from ischemic heart disease (IHD). Majority of chest pain victim initially report to his family physician. At times, sudden death is the first and last manifestation of IHD. Doctors are aware of various risk factors for IHD. The diagonal ear lobe crease (DELC) has been characterized in medical literature as a surrogate marker which can be easily identified as high-risk case for impending IHD. We report here the incidence of IHD accompanied with DELC in rural population.Patients and Methods:Eight hindered and eighty eight patients attended to general physician Mahad during January 2012 to December 2015 with complaints of chest pain were investigated for presence of DELC. Presence of DELC was correlated to varies risk factors including hypertension, hyperlipidemia, diabetes mellitus (DM), body mass index (BMI), occipital baldness, and tobacco consumption.Results:Out of patients studied, 645 (72.6%) had hypertension, 508 (57.2%) had DELC, of these 486 (95%) suffered from IHD, 246 (48%) had DM, 246 (48%) had occipital baldness, and 325 (64%) had hyperlipidemia. Significant association between BMI > 25+ in male >50 years old with odd ratio 2.08 (95% CI: 1.27–3.39; P = 0.003).Interpretation:Presence of DELC with or without risk factors is a simple clinical observation easily noted during examination by family physician to investigate and to rule out IHD.

DIAGONAL EARLOBE CREASE, CEREBRAL SMALL VESSEL DISEASE, AND BETA-AMYLOIDOSIS IN COGNITIVELY IMPAIRED PATIENTS

Diagonal earlobe crease (DELC) has been proposed as a marker of generalized atherosclerosis. In this study, we investigated the frequency and clinical significance of DELC in patients with cognitive impairment using imaging biomarkers measured by white matter hyperintensities (WMH) on MRI and amyloid PET. A total of 471 patients with cognitive impairment (271 patients with Alzheimer disease-related cognitive impairment [ADCI], and 200 patients with subcortical vascular cognitive impairment [SVCI]) and 243 cognitively normal (CN) individuals were included in this study. The ear lobes of study participants were assessed using 3D-reconstructed volumetric brain MRI scans. Multivariate logistic regression analyses were performed to determine whether imaging biomarkers were associated with the presence of DELC. Patients with cognitive impairment (ADCI and SVCI) had more DELC than CN individuals (58.3% vs. 41.7%, p = 0.001). Compared to subjects with none or mild degree of WMH, subjects with moderate to severe degree of WMH had more frequent DELC (OR 2.5, 95% CI 1.8 to 3.4, p < 0.001). In addition, ADCI and SVCI patients with amyloid positive had more frequent DELC than those with amyloid negative (OR 2.5, 95% CI 1.5 to 4.0, p < 0.001).

Diagonal earlobe crease associated with increased epicardial adipose tissue and carotid intima media thickness in subjects free of clinical cardiovascular disease.

Atherosclerotic coronary artery disease is a leading cause of death, worldwide. Diagonal earlobe crease (DELC) has been suggested as a simple, noninvasive marker of cardiovascular disease. Although epicardial adipose tissue (EAT) thickness and carotid intima media thickness (CIMT) are closely related to atherosclerosis, the relation between EAT, CIMT, and DELC had yet to be studied. The present objective was to analyze this association. Subjects were apparently healthy individuals referred to the cardiology outpatient clinic. A total of 65 subjects with DELC and 65 age- and sex-matched controls without DELC were enrolled. EAT thickness and CIMT were measured and analyzed. Epicardial adipose tissue thickness was significantly higher in the DELC group (0.57±0.12 vs. 0.35±0.05; p<0.0001). CIMT was also significantly higher in DELC group (0.85±0.16 vs. 0.60±0.15; p<0.0001). Correlation analysis showed that CIMT was significantly correlated with EAT thickness (r: 0.594; p<0.0001). Linear regression analysis showed that presence of DELC was independently associated with CIMT and EAT thickness. A significant and independent association between the presence of DELC and increased CIMT and EAT thickness was presently determined, for the first time, in subjects free of clinical cardiovascular disease.

The Combined Effect of Ear Lobe Crease and Conventional Risk Factor in the Diagnosis of Angiographically Diagnosed Coronary Artery Disease and the Short-Term Prognosis in Patients Who Underwent Coronary Stents.

The role of diagonal ear lobe crease (DELC) in coronary artery disease (CAD) diagnosis and prognosis remains controversial. In this study, we aimed to assess the combined effect of DELC with other conventional risk factors in the diagnosis and prognosis of CAD in Chinese patients who underwent angiography and coronary stent implantation.The study consisted of 956 consecutive patients who underwent angiography. The DELC was identified as no DELC, unilateral, and bilateral DELC. The conventional risk factors for CAD were recorded.Our dada showed that the overall presence of DELC is associated with CAD risk. Stratification analyses revealed that the diagnostic value of DELC was mostly significant in those with >4 risk factors. Also in patients with >4 risk factors, the presence of bilateral DELC remains to be associated with higher hs-CRP level, higher severity of CAD, and higher possibility of developing major adverse cardiac events after successful percutaneous coronary intervention (PCI).Our study confirmed the relation of DELC with CAD in Chinese patients; more importantly, our data suggest the combination of DELC and CAD risk factors will help to predict the incidence of CAD and may predict the prognosis after successfully PCI.

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

Controversy exists concerning the relation between diagonal ear lobe crease (DELC) and coronary artery disease (CAD). We examined whether DELC is associated with CAD using coronary computed tomography (CT) angiography. We studied 430 consecutive patients without a history of coronary artery intervention who underwent CT angiography on a dual-source scanner. Presence of DELC was agreed by 2 blinded observers. Two blinded readers evaluated CT angiography images for presence of CAD and for significant CAD (≥50% stenosis). Chi-square and t tests were used to assess demographic differences between subgroups with and without DELC and the relation of DELC to 4 measurements of CAD: any CAD, significant CAD, multivessel disease (cutoff ≥2), and number of segments with plaque (cutoff ≥3). Multivariable logistic regression was performed to adjust for CAD confounders: age, gender, symptoms, and CAD risk factors. Mean age was 61 ± 13 and 61% were men. DELC was found in 71%, any CAD in 71%, and significant CAD in 17% of patients. After adjusting for confounders, DELC remained a significant predictor of all 4 measurements of CAD (odds ratio 1.8 to 3.3, p = 0.002 to 0.017). Sensitivity, specificity, and positive and negative predictive values for DELC in detecting any CAD were 78%, 43%, 77%, and 45%. Test accuracy was calculated at 67%. Area under the receiver operator characteristic curve was 61% (p = 0.001). In conclusion, in this study of patients imaged with CT angiography, finding DELC was independently and significantly associated with increased prevalence, extent, and severity of CAD.

Associação entre doença arterial coronariana e as pregas lobular diagonal e anterotragal em homens

FUNDAMENTOS: Diversas alterações dermatológicas foram associadas à doença arterial coronariana, representando achados de fácil constatação que podem contribuir na estratificação não invasiva do risco cardíaco. OBJETIVOS: Avaliar comparativamente a prevalência de certos achados dermatológicos em pacientes com ou sem doença arterial coronariana. MÉTODOS: Estudo caso/controle envolvendo pacientes do sexo masculino submetidos à cineangiocoronariografia. Foram considerados aqueles casos com obstrução de mais de 50% em pelo menos uma coronária. Avaliou-se a presença da prega lobular diagonal, prega anterotragal, alopecia e presença de pêlos no tórax nos dois grupos. Os resultados foram ajustados para os fatores de risco: tabagismo, hipertensão, diabetes, idade, dislipidemia e índice de massa corporal. RESULTADOS: Analisaram-se 110 pacientes (80 casos e 30 controles). A prevalência da prega lobular diagonal nos casos (60,0%) foi maior do que no grupo controle (30,0%) (p&lt;0,05). Alopecia androgenética e distribuição de pêlos no tórax não demonstraram associação positiva com coronariopatia neste estudo. O Odds Ratio (IC 95%), da prega lobular diagonal foi de 3,1 (1,2-8,3) e para prega anterotragal foi de 5,5 (1,9-16,3). A verificação simultânea da prega lobular diagonal e prega anterotragal representou valor preditivo positivo de 90%. CONCLUSÕES: Detectou-se associação positiva entre a presença da prega lobular diagonal bilateral e prega anterotragal bilateral com doença arterial coronariana, sendo que a presença simultânea das duas pregas apresenta alta preditividade para doença arterial coronariana.

Ölüm Nedeninin Tespitinde Yardımcı Bir Bulgu Diagonal Kulak Lobu Çizgisi

Koroner arter hastalıkları, doğal sebeplerle meydana gelen ölüm nedenlerinin başında gelmektedir. Bu hastalıkların yüksek insidans ve mortalité oranları, bilinen risk faktörlerinden çok, olası risk faktörlerinin araştırılmasını gerekli kılmıştır. Bir fizik muayene bulgusu olan diagonal kulak lobu çizgisi (DKLÇ), 1973 yılında tanımlanmıştır. Çalışmamızda, DKLÇ’nin, ölü muayenesi yapan hekim için ölüm nedeninin tespitinde yardımcı bir bulgu olup olamayacağının saptanması amaçlanmıştır. Çalışmamızın bulguları, vakalara uygulanan anjiografiler sonucunda; a. coronaria sinistranın dalları olan ramus interventricularis anterior (RIA) ve ramus circumflexus (RC) ile a. coronaria dextra’da (ACD) saptanan daralma yüzdeleri arttıkça DKLÇ görülme sıklığının da arttığını göstermektedir. Bu durum DKLÇ ve koroner arter hastalıkları arasmda anlamlı ilişkiler bildiren daha önceki çalışmaların bulguları ile uyumludur. Özellikle öyküye ulaşma olanağı bulunmayan ve herhangi bir travmatik bulgu saptanmayan vakalarda DKLÇ’nin, ölümün koroner arter hastalığından meydana geldiği yönünde destekleyici bir bulgu olarak muayeneyi yapan hekimin dikkatini çekmesi gereken bir işaret olduğunu düşünmekteyiz.Anahtar kelimeler: Diagonal kulak lobu çizgisi, koroner arter hastalığı, ölü muayenesi.

Bilateral Diagonal Earlobe Crease and Coronary Artery Disease: A Significant Association

Background: The association between the presence of diagonal earlobe crease (ELC) and coronary artery disease (CAD) still remains controversial. Objective: The aim of this study was to evaluate the association between bilateral ELC and CAD. Methods: 415 patients were examined for the presence or absence of bilateral ELC, angiographic evidence of CAD and coronary risk factors. The patients were divided into 2 groups according to angiographic evidence of CAD. Results: Bilateral ELC was significantly and positively correlated with CAD, hypertension, age, male gender, cigarette smoking and family history of CAD. The ELC was an independent variable for CAD. The observed sensitivity, specificity, positive predictive value and negative predictive value of the bilateral ELC for the diagnosis of CAD were in the following order: 51.3, 84.8, 89.4 and 41.2%. Conclusion: The presence of bilateral ELC was significantly associated with CAD and coronary risk factors. The bilateral ELC was an important dermatological indicator of CAD, and it might be a useful diagnostic tool in the clinical examination of patients.