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The relationship of diagonal earlobe crease (Frank’s sign) and obstructive coronary artery disease in patients undergoing coronary angiography

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Summary

Background

Traditional risk factors for cardiovascular disease (CVD) play an important role in the clinical evaluation of patients with symptoms suggestive of coronary artery disease (CAD). The utility of the diagonal earlobe crease (DELC) in predicting the presence of CAD is controversial.

Purpose

To investigate the association between DELC, traditional CVD risk factors, and obstructive CAD.

Methods

This prospective study included 1377 patients (mean age 65 ± 10 years, 64% male) who underwent invasive coronary angiography for suspected acute or chronic coronary syndromes. In addition to routine clinical assessment, all patients underwent visual examination of both earlobes for the presence of DELC. All assessments were made by three independent readers, with a majority vote in the case of disagreement. Obstructive CAD was defined by invasive coronary angiography as > 50% stenosis of the left main coronary artery or > 70% stenosis in any other major epicardial coronary artery.

Results

Bilateral DELC was observed more frequently in patients with obstructive CAD than in those without it (67% vs. 33%, p = 0.022). In the multivariate logistic regression model, bilateral DELC was independently associated with CAD (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.07–1.74), along with smoking (OR 1.86, 95% CI 1.44–2.38), diabetes mellitus (OR 1.67, 95% CI 1.29–2.15), male sex (OR 2.04, 95% CI 1.61–2.58), and dyslipidemia (OR 1.54, 95% CI 1.12–2.30); however, the diagnostic accuracy of DELC was modest and resembled that of traditional CVD risk factors.

Conclusion

Despite being independently associated with obstructive CAD, DELC is not a reliable stand-alone clinical marker of CAD due to modest diagnostic accuracy.

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Authors and Affiliations

  1. Department of Cardiology, Clinical Hospital Centre Zemun, Belgrade, Serbia

    Branka Gakovic, Sofija Aleksandra Neskovic, Ivona Vranic, Katarina Grujicic, Stefan Mijatovic, Aleksandra Ljubojevic & Ivan Stankovic

  2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Ivan Stankovic

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  1. Branka Gakovic
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  2. Sofija Aleksandra Neskovic
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  3. Ivona Vranic
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  4. Katarina Grujicic
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  5. Stefan Mijatovic
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  6. Aleksandra Ljubojevic
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  7. Ivan Stankovic
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Correspondence to Branka Gakovic.

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Conflict of interest

B. Gakovic, S.A. Neskovic, I. Vranic, K. Grujicic, S. Mijatovic, A. Ljubojevic and I. Stankovic declare that they have no competing interests.

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All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Gakovic, B., Neskovic, S.A., Vranic, I. et al. The relationship of diagonal earlobe crease (Frank’s sign) and obstructive coronary artery disease in patients undergoing coronary angiography. Wien Klin Wochenschr 135, 667–673 (2023). https://doi.org/10.1007/s00508-023-02297-y

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