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The earlobe crease, coronary artery disease, and sudden cardiac death - An autopsy study of 520 individuals
Abstract
The majority of previous studies have demonstrated a correlation between diagonal earlobe creases (ELC) and coronary artery disease (CAD). In this study of 520 forensic autopsy cases, the earlobes were studied and photographed before autopsy, and the existence of a diagonal ELC was noted in 55%. The cause of death, the degree of coronary atherosclerosis, aortosclerosis, and cerebrosclerosis, as well as heart, kidney, and spleen weights, were noted in each case. The body mass index (BM\I), thickness of abdominal fat, baldness, and excessive hair in the meatus externa of the external ears were also assessed. 'Nonparametric methods were used in the statistical calculations. It was found that ELC was strongly correlated with CAD in both men and women (P < 0.0001) but with sudden cardiac death (SCD) only in men (P < 0.04). The sensitivity of the ELC sign was 75% and the positive predictive value (ppv) was 68%. In individuals below 40 years, the ppv was as high as 80%. Using multiple logistic regression analysis, ELC was found to be the strongest independent risk factor for CAD and SCD apart from age and BMI (both genders), as well as baldness and hair in the meatus externa (in males). It is concluded that in a patient population similar to that in the present study the ELC sign could be especially useful in screening for premature CAD in younger individuals.
... [2] Anatomically, both the earlobe and heart are supplied by the "end arteries." Microvascular disease has been found to be behind the development of ELC as has Suen et al., etc., [4][5][6][7][8][9][10][11][12][13] strongly showed that ELC was strongly associated the presence of CAD, while on the other hand, studies carried out by Jorde et al. [14] and Davis et al. [15] negated this hypothesis. The most important drawback of the previous studies was the lack of confirmation CAD by coronary angiogram (CAG), and there have been studies published from India, but they are handful in numbers such as those by Verma et al., Raman et al., and Amit; these studies also established the association of ELC with CAD. ...
... Since the association between CAD and ELC was first reported by Frank in 1973, it has been an area of immense debate. The association between ELC and CAD has been confirmed in several studies across varied geographical distribution with the prevalence of ELC among CAD-positive patients ranging from 41% to 82%, as illustrated in Table 2. [4][5][6][7][8][9][10][11][12][13][16][17][18] In our study, 74% of the patients of CAD proven on coronary angiography had an ELC. This finding is similar to the findings of the studies carried out by Wang et al. (82%), [9] Hou et al. (78%), [10] and Shmilovich et al. (71%). ...
... Other studies carried out earlier differed on this aspect. Amit (2016) reported no difference in the prevalence of risk factors, whereas other studies such as those by Shmilovich et al., [6] Edston, [5] and Raman et al. [17] did not include an assessment of the individual risk factors. The observation derived from our study is temporally correct in a sense that if the presence of ELC suggests an increased chance of CAD, then it should also be associated with increased prevalence of the risk factors known to cause CAD. ...
... [2] Anatomically, both the earlobe and heart are supplied by the "end arteries." Microvascular disease has been found to be behind the development of ELC as has Suen et al., etc., [4][5][6][7][8][9][10][11][12][13] strongly showed that ELC was strongly associated the presence of CAD, while on the other hand, studies carried out by Jorde et al. [14] and Davis et al. [15] negated this hypothesis. The most important drawback of the previous studies was the lack of confirmation CAD by coronary angiogram (CAG), and there have been studies published from India, but they are handful in numbers such as those by Verma et al., Raman et al., and Amit; these studies also established the association of ELC with CAD. ...
... Since the association between CAD and ELC was first reported by Frank in 1973, it has been an area of immense debate. The association between ELC and CAD has been confirmed in several studies across varied geographical distribution with the prevalence of ELC among CAD-positive patients ranging from 41% to 82%, as illustrated in Table 2. [4][5][6][7][8][9][10][11][12][13][16][17][18] In our study, 74% of the patients of CAD proven on coronary angiography had an ELC. This finding is similar to the findings of the studies carried out by Wang et al. (82%), [9] Hou et al. (78%), [10] and Shmilovich et al. (71%). ...
... Other studies carried out earlier differed on this aspect. Amit (2016) reported no difference in the prevalence of risk factors, whereas other studies such as those by Shmilovich et al., [6] Edston, [5] and Raman et al. [17] did not include an assessment of the individual risk factors. The observation derived from our study is temporally correct in a sense that if the presence of ELC suggests an increased chance of CAD, then it should also be associated with increased prevalence of the risk factors known to cause CAD. ...
... In a Swedish autopsy study, 55% of 520 subjects (420 males, mean age 56) had diagonal ELC [70]. There was no significant difference between the presence of ELC in males (53.8%) and females (60%). ...
... The ELC was unilateral in 8.8% and bilateral in 91.2% of the subjects. The prevalence of ELC was 65.4% in those with CAD and 73.3% in victims of sudden cardiac death, a difference which was significant when compared with 46.1% and 57.9%, respectively in the control groups [70]. The sensitivity, specificity and positive and negative predictive values for those < 40 years old were 0.68, 0.84, 0.80, 0.72, respectively; for those between ages 40 and 50 years old, they were 0.68, 0.60, 0.63, 0.66, respectively; and for those over 60 years old they were 0.79, 0.33, 0.51, 0.61, respectively [70]. ...
... The prevalence of ELC was 65.4% in those with CAD and 73.3% in victims of sudden cardiac death, a difference which was significant when compared with 46.1% and 57.9%, respectively in the control groups [70]. The sensitivity, specificity and positive and negative predictive values for those < 40 years old were 0.68, 0.84, 0.80, 0.72, respectively; for those between ages 40 and 50 years old, they were 0.68, 0.60, 0.63, 0.66, respectively; and for those over 60 years old they were 0.79, 0.33, 0.51, 0.61, respectively [70]. The authors concluded that ELC could be useful in screening for premature CAD in younger individuals [70]. ...
The ear lobe crease (ELC) has been defined as a deep wrinkle that extends backwards from the tragus to the auricle. It has been proposed that ELC is a predictor of coronary artery disease (CAD). In this review, we consider the possible association between ELC and CAD. Our aim is to systematically address all the relevant evidence in this field. There are many studies that support an association between ELC and CAD. However, other studies did not find such an association. A recent meta-analysis supports the hypothesis that ELC could be a marker of CAD. However, several limitations raise doubts as to whether we should accept this link.
... The majority of studies have shown a significant association between CAD and the presence of diagonal earlobe creases (DELC) since Frank's first report in 1973 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Regarding myocardial infarction, Lichstein et al. [3] reported in 1974 that DELC (unilateral or bilateral) was significantly more common (47%) in patients with myocardial infarction than those without the disease (30%). ...
... times higher than those without a crease [13]. A study of 520 individuals in Swedish showed that DELC was strongly predictive of the presence of CAD and was strongly associated with sudden cardiac death in men, but not women [14]. ...
... In terms of gender, our results showed that DELC was predominantly distributed in male sex, this didn't echoed the clinical and postmortem finding which reported almost equally distribution in both sexes [7,8,13]. On par with studies previously documented [7,14,20,23,31] we also found an increasing trend of DELC prevalence with increasing age, but age was not a positive predictor for CAD and the relationship of DELC with CAD was independent of age and sex. Regarding race, the attainable results were confounding. ...
Many reports have claimed associations between diagonal earlobe crease (DELC) and coronary artery disease (CAD), but data in Chinese populations are limited.
This cohort study investigated 449 consecutive Chinese, 250 cases with CAD and 199 without CAD, who were certified by coronary artery angiography in our center. Characteristic differences and the relation of DELC to CAD were assessed by Chi-square and t tests. The multivariate regression was performed to adjust for confounders and ROCs mode were used to detect its predicting performance for CAD.
The prevalence of DELC was 46.2% in those without CAD and 75.2% in those with CAD (P < .001). Subjects with DELC had more stenostic vessels and higher prevalence of both any and significant coronary artery stenosis than those without DELC (P < .001). The sensitivity, specificity and positive and negative predictive values for DELC to diagnose CAD in the whole population were 0.752, 0.538, 0.671 and 0.633. The higher sensitivity and positive predictive values (ppv) were found in male, the lowest sensitivity and the highest ppv in the <45 years old group, and the lowest specificity and ppv in the >75 years old group. After adjusting for other variables including age, gender and traditional risk factors, DELC remained a positive predictor for CAD (OR, 3.408; 95% CI 2.235-5.196; P < 0.001), but not for hypertension, diabetes mellitus, hypercholesterolemia and hypertriglyceridemia. ROC analysis showed the area under the curve was 0.645 (95% CI 0.593-0.697, p < 0.001).
The study showed a significant association between DELC and CAD independent of established risk factors in Chinese.
... Afterwards, many studies presented ELC as a marker for CAD [28,29] . In addition, a diagonal ELC has also been suggested as a marker of vascular disease in a population with diabetes (population with increased risk of microangiopathy); but only limited data are available [30] . The Fremantle Diabetes Study reported the prevalence of ELC to be 55% in the western Australian population [30] . ...
... In addition, a diagonal ELC has also been suggested as a marker of vascular disease in a population with diabetes (population with increased risk of microangiopathy); but only limited data are available [30] . The Fremantle Diabetes Study reported the prevalence of ELC to be 55% in the western Australian population [30] . In an Indian study, data suggested that the ELC was present in 59.7% of the diabetic population > 40 years in the urban south Indian population [31] . ...
... The above study showed that the subjects in the ELC group were older, had longer duration of diabetes and had poor glycemic control. These observations were in agreement with the Fremantle study [30] . Subjects with ELC had a higher socioeconomic status as compared to the group without ELC; this could be an indirect measure of the population at a greater risk of CAD. ...
Coronary artery disease (CAD) is rapidly increasing in prevalence across the world and particularly in south Asians at a relatively younger age. As atherosclerosis starts in early childhood, the process of risk evaluation must start quite early. The present review addresses the issue of cutaneous markers associated with atherosclerosis, and the strengths and weaknesses of the markers in identifying early coronary atherosclerosis. A diligent search for such clinical markers, namely xanthelasma, xanthoma, arcus juvenilis, acanthosis nigricans, skin tags, ear lobe crease, nicotine stains, premature graying in smokers, hyperpigmented hands in betel quid sellers, central obesity, and signs of peripheral vascular disease may prove to be a rewarding exercise in identifying asymptomatic CAD in high risk individuals.
... Desde entonces se ha seguido investigando y en general comprobando esta asociación en diferentes estudios clínicos (1,(9)(10)(11)(12), incluyendo su relación con la patología cerebrovascular (13,14). En estudios autópsicos también se ha estudiado, aunque cabe destacar que son escasos (2,4, 12,[15][16][17]. Por otro lado, y de forma muy minoritaria y en referencias antiguas, otros trabajos niegan dicha relación y lo justifican por la edad o la postura al dormir, mientras que otros sí que aceptan su valor predictivo, pero únicamente restringido a sujetos jóvenes (18-21). ...
... En particular, de las cinco principales series post mortem, todas excepto una están realizadas en el ámbito forense, el tamaño muestral varía entre 165-800 casos, la edad media presenta un rango de 34 a 74 años y la frecuencia global del PDL reportada oscila ampliamente de 23 a 72% (2,3, [15][16][17]. El método para analizar su presencia incluye tanto la visualización directa en el examen externo de la autopsia como el estudio retrospectivo en fotografías y solo en dos trabajos se utilizan grados para valorar la severidad del pliegue (2,3). ...
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.
... 22 After that report, three more autopsies studies (sample size ranges from 100 to 520 subjects) found that ELC was not only significantly associated with coronary atherosclerotic disease but the strongest risk factor for coronary heart disease, cardiovascular death independently of age. [23][24][25] Taking all this evidence together, it is difficult to define a definitive pathway that fully explains this association and perhaps those associations rely on multiple causal pathways. ...
... 22 Other smaller post-mortem studies showed an independent association between the earlobe and coronary atherosclerosis. [23][24][25] In one case-control study that recruited 100 cases and 100 control subjects, the presence of ELC (unilateral or bilateral) increased the odds of having angiographic proven CHD by 5.63 (CI 95%: 2.917-10.938; p= <0.00). ...
Traditionally a crease in the ear has been considered a visible marker of atherosclerosis. There is strong evidence of its association with coronary heart disease (CHD) revealed in several retrospective and prospective studies. However, the usefulness of the earlobe crease (ELC) as a marker of atherosclerotic diseases of other vascular beds, especially in the intracranial or extracranial carotid vasculature, is not clear. A non-systematic search of studies evaluating the association between ELC and atherosclerosis was performed. Observational studies that explored the association of ELC with atherosclerosis in many vascular beds were reviewed. Most studies presented methodological limitations, selection bias, and relatively small sample sizes. Discrepancies were found between studies, mainly due to the interaction of age in the association pathway. In a population cohort study, age was the main modifier of the effect of ELC with atherosclerosis in different vascular beds. The role of ELC as a marker of atherosclerosis remains unclear, at least for extra-coronary atherosclerosis.
... The cholesterol level was significantly higher in stage 3 compared with stages 1 or 2. 29 In 2006 Edston studied 520 forensic autopsy cases. 30 The Frank sign was noted in 55% of the autopsies. The cause of death and the degree of atherosclerosis were studied in each case. ...
... Edston suggested that the Frank sign could be a useful screening test for premature atherosclerosis in younger individuals. 30 ...
Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time. An interesting example of such signs is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. Our goal was to summarize the clinical trials and observational studies that had examined the association between the Frank sign and cardiovascular diseases. Summarizing the 57 studies we found showed that this association could be used for early diagnosis of coronary and vascular diseases in the preclinical stage and that they were found in different populations around the world. Autopsy studies also found a strong association between the Frank sign and cardiovascular causes of death in both sexes. Cardiovascular causes of death included ischemic and hypertensive heart disease, calcific valvular stenosis, ruptured dissecting aneurysm of the thoracic aorta, and ruptured atheromatous aneurysm of the abdominal aorta. The Frank sign was correlated with increased intima-media thickness and stroke and was found in patients with peripheral vascular disease and with cardiovascular risk factors. The Frank sign could serve as a physical sign to help clinicians diagnose cardiovascular diseases.
... However, the association between the presence of diagonal earlobe crease (ELC) as a physical sign and coronary artery disease (CAD) was first reported by Frank in 1973. 1 Afterwards, many studies presented ELC as a marker for coronary artery disease. [2][3][4][5][6][7] However, several reports rejected the value of the sign or totally denied the association. [8][9][10] The pathophysiologic link between ELC and CAD has been difficult to ascertain. ...
... The association between ELC and CAD has been confirmed in several studies in other countries such as USA, Denmark, Poland, Brazil, Japan and Turkey as different geographic areas. [2][3][6][7][15][16] Most studies were based on clinical criteria of CAD was diagnosis, laboratory signs or angiography. The association between ELC and CAD also confirmed in the postmortem findings of Cumberland 4 and Ishii. ...
Objectives: Diagonal ear lobe crease (ELC) has been introduced as a diagnostic physical sign for coronary artery disease (CAD) and the aim of this study was to evaluate the association between ELC and CAD in Iranians. Methodology: In a cross- sectional study, 106 consecutive patients, referred from cardiologists for angiography, were studied for presence of ELC and CAD in four academic hospitals in Tehran. ELC categorized based on Ishii classification and CAD defined as at least 50% narrowing in one of the three major epicardial vessels. Results: The average age in 70 men and 36 women was 50.14±14.11 years. Based on angiographic results, patients were divided in two groups. In 57 patients of CAD positive group, 34 patients had ELC and in 49 patients of CAD negative group only 13 patients had ELC. (P<0.05) After adjusting for age, ELC was a significant predictor of CAD (P<0.05). The severity of ELC (size and unilateral or bilateral) was significantly related to presence of CAD (P<0.05). The observed sensitivity, specificity, positive predictive value and negative predictive value of ELC for diagnosis of CAD were in the following order: 59.6%, 73.5%, 72.3% and 61% Conclusions: In Iranians, the presence of ELC is associated with CAD.
... However, the association between the presence of diagonal earlobe crease (ELC) as a physical sign and coronary artery disease (CAD) was first reported by Frank in 1973. 1 Afterwards, many studies presented ELC as a marker for coronary artery disease. [2][3][4][5][6][7] However, several reports rejected the value of the sign or totally denied the association. [8][9][10] The pathophysiologic link between ELC and CAD has been difficult to ascertain. ...
... The association between ELC and CAD has been confirmed in several studies in other countries such as USA, Denmark, Poland, Brazil, Japan and Turkey as different geographic areas. [2][3][6][7][15][16] Most studies were based on clinical criteria of CAD was diagnosis, laboratory signs or angiography. The association between ELC and CAD also confirmed in the postmortem findings of Cumberland 4 and Ishii. ...
Objectives: Diagonal ear lobe crease (ELC) has been introduced as a diagnostic physical sign for coronary artery disease (CAD) and the aim of this study was to evaluate the association between ELC and CAD in Iranians. Methodology: In a cross-sectional study, 106 consecutive patients, referred from cardiologists for angiography, were studied for presence of ELC and CAD in four academic hospitals in Tehran. ELC categorized based on Ishii classification and CAD defined as at least 50% narrowing in one of the three major epicardial vessels. Results: The average age in 70 men and 36 women was 50.14±14.11 years. Based on angiographic results, patients were divided in two groups. In 57 patients of CAD positive group, 34 patients had ELC and in 49 patients of CAD negative group only 13 patients had ELC. (P<0.05) After adjusting for age, ELC was a significant predictor of CAD (P<0.05). The severity of ELC (size and unilateral or bilateral) was significantly related to presence of CAD (P<0.05). The observed sensitivity, specificity, positive predictive value and negative predictive value of ELC for diagnosis of CAD were in the following order: 59.6%, 73.5%, 72.3% and 61% Conclusions: In Iranians, the presence of ELC is associated with CAD.
... [1] The diagonal earlobe crease (DELC) is a fold or crease in the skin of the earlobe [ Figure 1] [2] and was first suggested to be associated with coronary artery disease (CAD) in 1973 by Frank, [3] and after that this crease was called Frank's sign. Since Frank's original study, several clinical studies, including autopsy-based [4] and histopathological examinations, [5] have shown an association between ELC and CAD [6,7] and support the O riginal Article hypothesis that ELC was related to CAD. The ELC is useful as a risk factor of CAD, because it can be seen at a glance. ...
... [11] In Australia, Davis et al. [12] reported that the prevalence of ELC was 55% in CAD patients. A study by Edston [4] of autopsy cases, the existence of a DELC was noted in 55%. It was found that ELC was strongly correlated with CAD in both men and women. ...
Background: The diagonal earlobe crease (DELC) has been proposed to be a marker of coronary artery disease (CAD), but this association still remains controversial. The aim of the present study was to evaluate the frequency of DELC in patients with CAD. Materials and Methods: Eighty patients with angiographically documented CAD from Borujerd were evaluated for the presence or absence of ELC. The ELC was said to be present if the patient had a deep diagonal crease extending obliquely from the outer ear canal toward the border of the earlobe without discontinuity covering at least two-thirds of the ear lobe length. Results: The prevalence of DELC was 58.7% (95% confidence interval: 61.1-55.3). The frequency of hypertension and dyslipidemia was significantly higher in patients with DELC (P = 0.002 and P = 0.034, respectively). But no such difference was seen between diabetic and nondiabetic patients (P = 0.241). Conclusion: The frequency of DELC in patients with CAD was high in our study. The data suggest that the ELC sign may be a useful marker for the presence of CAD in patients.
... A Swedish forensic necropsy study of death among 420 males and 100 females demonstrated that 55% (286/520) had DELC. 14 The crease was equally common in both sexes (53.8% of men and 60% of women; the difference between the sexes not being statistically significant). A unilateral DELC was noted in 8.8% (25/286) of individuals, whereas a bilateral DELC was noted in 91.2% (261/286) of individuals. ...
... 37,40 Others have contradicted this assertion by demonstrating that while the prevalence of DELC and ACA increases with increasing age, the association between DELC and ACA continues to be statistically significant independent of the patient's chronological age. 7,9,10,13 The issue of prevalence of DELC among various ethnic groups was raised earlier, when we noted that among northern Europeans coming to autopsy (mean age 60) the prevalence of DELC is 75%, 14 which is far greater than the prevalence among native Japanese where it is only 5%. 10 In addition, in San Francisco, a study conducted using police arrest photographs ("mug shots") to determine the prevalence of DELC in various racial groups of persons aged 46 to 65 years produced rather surprising results. 43 The rates of DELC were as follows: Hawaiian-Samoans 0% (0/12), Chinese 21% (6/29), blacks 37.9% (44/116), Latin Americans 47.5% (19/40), and Caucasians 50.8% (62/ 122). ...
A significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodromal symptoms. A diagonal ear lobe crease (DELC) has been characterized in the medical literature as a marker that can identify high-risk patients having occult atherosclerosis. The oral and maxillofacial surgery literature, however, offers very little information on the subject.
The authors conducted a MEDLINE search using the key terms "earlobe crease," "ear lobe crease," "atherosclerosis," "cardiovascular disease," and "cerebrovascular disease." They selected articles published in peer-review journals and gave preference to articles reporting randomized controlled trials.
A majority of clinical, angiographic, and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. Of particular interest to oral and maxillofacial surgeons is the reported association between individuals with DELC and the development of morbid cardiovascular events associated with the administration of general anesthesia. More recently, reports using B-mode ultrasound have also linked DELC to atherosclerosis of the carotid artery, and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. A minority of studies have, however, failed to support the association between DELC and atherosclerosis.
DELC is readily visible during presurgical/preanesthetic physical examination and, in conjunction with the patient's medical history, vital signs, and panoramic radiograph, may assist in risk assessment and the identification of individuals needing further evaluation.
... Varios estudios previos encontraron relación positiva entre el signo de Frank y riesgo cardiovascular. Edston 2005, encontró asociación estadística entre el pliegue de Frank y muerte de hombres y mujeres con enfermedades coronarias (16). Los pacientes con mayor edad que presentaron el signo de Frank son los que presentan una mayor relación con riesgo cardiovascular, este resultado es apoyado por el estudio de Shmilovish 2012, que basado en literatura previa y su investigación encontró que el síndrome de Frank está asociado con alto, moderado y bajo riesgo cardiovascular al y reporta que la edad es la variable que más influencia la asociación del pliegue de Frank como indicadito de riesgo cardiovascular (17). ...
Antecedentes y Objetivo: La diabetes mellitus tipo 2 es una de las patologías con mayor prevalencia en el
mundo. En 2015 se estima que aproximadamente 5 millones de personas murieron de diabetes y, en la
mayoría de los casos, fue como resultado de complicaciones cardiovasculares, en Ecuador se estima que el
7,3% de la población sufre de diabetes. Una técnica de detectar riesgos cardiovasculares es mediante el
pliegue en el lóbulo de la oreja o signo de Frank. Los objetivos de la presente investigación fueron: medir el
riesgo cardiovascular con relación al sexo y edad, conocer la presencia del signo de Frank en relación con el
sexo y edad, y relacionar el riesgo cardiovascular y la presencia del signo de Frank en relación al sexo y edad.
Materiales y método: estudio de tipo descriptivo, con enfoque cuantitativo en 109 pacientes con diabetes tipo
2 en el Centro de Salud número 3 tipo B de Loja.
Resultados: el riesgo de padecer enfermedades cardiovasculares es menor en mujeres (n=86), el riesgo de
enfermedades cardiacas es directamente proporcional al incremento de edad especialmente en el grupo de
77-94 años (n=8), la presencia del signo de Frank se presenta en ambos sexos (n=109) los cuales en su
mayoría estaban en el rango de edad comprendido entre 56-76 años (71,4%), y los hombres presentan riesgo
mayor de sufrir enfermedades cardiovasculares.
Conclusiones: Se concluye que el signo de Frank ayuda a medir el riesgo cardiovascular en pacientes con
diabetes.
... Interestingly, individuals under the age of 40 years had the highest positive predictive value of 80%. The authors also reported a correlation of DEC with sudden cardiac death in men [16]. Within patients referred for coronary angiogram, a Chinese study revealed that at presence of more than four risk factors and of bilateral DEC a higher chance of major adverse cardiac events (MACE) after successful percutaneous coronary intervention (PCI) [17]. ...
Background
The association between the presence of a diagonal earlobe crease (DEC) and coronary artery disease has been prescribed earlier. However, it is unclear whether patients with acute myocardial infarction (AMI) and DEC have a higher risk of dying.
Methods
Study participants were persons with AMI who were included in the KORA Myocardial Infarction Registry Augsburg from August 2015 to December 2016. After taking pictures of both earlobes, two employees independently assessed the severity of DEC in 4°. For analysis, the expression of the DEC was dichotomized. Information on risk factors, severity and therapy of the AMI was collected by interview and from the medical record. Vital status post AMI was obtained by population registries in 2019. The relationship between DEC and survival time was determined using Cox proportional hazards models.
Results
Out of 655 participants, 442 (67.5%) showed DEC grade 2/3 and 213 (32.5%) DEC grade 0/1. Median observation period was 3.06 years (5–1577 days). During this period, 26 patients (12.2%) with DEC grade 0/1 and 92 patients (20.8%) with grade 2/3 died (hazard ratio 1.91, 95% confidence interval (CI) 1.23–2.96, p = 0.0037). In the fully adjusted model, patients with DEC grade 2/3 had a 1.48-fold increased risk of death compared to the DEC grade 0/1 patient group (CI 0.94–2.34, p = 0.0897). The fully adjusted model applied for 1-year survival revealed a significant, 2.57-fold hazard ratio of death (CI 1.07–6.17, p = 0.0347) for the patients with DEC grade 2/3.
Conclusions
Our results indicate that DEC is independently associated with 1-year AMI survival.
... Although increased kidney and spleen mass has been reported in patients with sudden cardiac death compared with noncardiac death, 23 the reasons for this are unexplored. One possibility is that increased intrathoracic and intra-abdominal organ mass may reflect edema from acute biventricular failure in sudden cardiac death, hence implicating a common terminal process (ie, cardiovascular cause of sudden death) in those with iMVP and AMI related sudden death. ...
Background
The association between mitral valve prolapse (MVP) and sudden death remains controversial. We aimed to describe histopathological changes in individuals with autopsy‐determined isolated MVP ( iMVP ) and sudden death and document cardiac arrest rhythm.
Methods and Results
The Australian National Coronial Information System database was used to identify cases of iMVP between 2000 and 2018. Histopathological changes in iMVP and sudden death were compared with 2 control cohorts matched for age, sex, height, and weight (1 group with noncardiac death and 1 group with cardiac death). Data linkage with ambulance services provided cardiac arrest rhythm for iMVP cases. From 77 221 cardiovascular deaths in the National Coronial Information System database, there were 376 cases with MVP . Individual case review yielded 71 cases of iMVP . Mean age was 49±18 years, and 51% were women. Individuals with iMVP had higher cardiac mass (447 g versus 355 g; P <0.001) compared with noncardiac death, but similar cardiac mass (447 g versus 438 g; P =0.64) compared with cardiac death. Individuals with iMVP had larger mitral valve annulus compared with noncardiac death (121 versus 108 mm; P <0.001) and cardiac death (121 versus 110 mm; P =0.002), and more left ventricular fibrosis (79% versus 38%; P <0.001) compared with noncardiac death controls. In those with iMVP and witnessed cardiac arrest, 94% had ventricular fibrillation.
Conclusions
Individuals with iMVP and sudden death have increased cardiac mass, mitral annulus size, and left ventricular fibrosis compared with a matched cohort, with cardiac arrest caused by ventricular fibrillation. The histopathological changes in iMVP may provide the substrate necessary for development of malignant ventricular arrhythmias.
... Overall, these studies confirm that the presence of DELC is associated with an up to five-fold increased risk of CAD. Therefore, the search for this sign has been suggested as a screening tool for atherosclerosis in young subjects [22]. ...
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.
... This study showed in table (2) relationship between that ELC and PAC and CAD. This is consistent with Edston et al 2006 when we found that among northern Europeans coming to autopsy (mean age 60) the prevalence of DELC is 75% [18]. ...
There are several dermatological indicators associated with Coronary Artery Disease CAD, which contribute the early diagnosis the seriousness of coronary artery disease. It is these indicators Diagonal Earlobe Crease DELC, which showed some studies a relationship between them and coronary artery disease, but Iraqi population data are limited. Therefore included the study (100) Iraqi samples has been taken from patients with CAD and 50 without CAD. The results showed values cardiac risk factors, which included the age, Body Mass Index BMI, Hypertension, Diabetes, Hypercholesterolemia, Hypertriglycerimia. HDL, as it was increased significantly the patients with CAD compared to controls. Results showed prevalence of ELC and PAC was 64%, 73% respectively in those with CAD while the prevalence of ELC and PAC was 11%, 16 % respectively in those without CAD. Cases with DELC were increased prevalence significantly of both any, associated with coronary artery than those without DELC. The odds ratio for diagonal earlobe crease was 6.30, and for Preauricular crease was 5.74.
... Shrestha et al., a Japanese neurologist, studied preoperatively screened carotid artery Doppler ultrasound studies obtained for patients with a prior history of cardiovascular/cerebrovascular disease noting that only male patients evidenced a significant correlation between DELC and atherosclerotic plaque. 11 Confirmation of the relationship between DELC and MI and stroke has been corroborated by clinical studies (enrolling a mixed-gender or predominantly male cohort) conducted in Finland, 12 Denmark, 13 Japan, 14 United Kingdom, 15 Turkey, 16 Sweden, 17 20 These reports prompted an American oral and maxillofacial surgeon to conduct a pilot observational study which demonstrated that 9 of 10 consecutive neurologically asymptomatic patients (mean age 65) with calcified carotid artery plaque (CCAP) (Figure 2) on their PI manifested DELC (8 bilateral and 1 unilateral) upon clinical examination. 21 The clinical correlate to this finding was established earlier by this same surgeon in collaboration with a neurologist by their study. ...
Objectives:
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 vali-dated "risk indicator" of future MIs. The diagonal ear lobe 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.
Methods:
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+.
Results:
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 demon-strated 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 signifi-cantly (p = .00011) more likely to evidence DELC+ on clinical examina-tion.
Conclusions:
Males with atherosclerosis of their carotid arteries as evi-denced by PIs displaying calcified atheromas are significantly more likely to evidence a DELC+ than those without an imaged atheroma.
... Estos resultados han sido corroborados en otras publicaciones y validados en análisis de autopsia en los que se ha encontrado que la hendidura del lóbulo, sobre todo si es bilateral, se asocia con mayor grado de aterosclerosis coronaria. [10][11][12][13][14][15] Algunos autores no han confirmado la asociación entre el signo de lóbulo hendido y factores de riesgo para cardiopatía isquémica. [16][17][18] Ishii 19 demostró, con base en un análisis de regresión multivariado, que la presencia, bilateralidad y profundidad de la hendidura se relaciona con la extensión y gravedad de la aterosclerosis aórtica y coronaria. ...
RESUMEN La mayoría de los estudios publicados han demostrado correlación entre el signo del lóbulo hendido y la cardiopatía isquémica. El signo se caracteriza por una hendidura diagonal que inicia en el borde inferior del conducto auditivo externo y se dirige hacia atrás al borde del lóbulo del pabellón auricular siguiendo un ángulo de 45 grados. El objetivo de este trabajo es revisar la evidencia científica relacionada con este interesante signo clínico. Palabras clave: Signo del lóbulo hendido, enfermedad cardiovascular, aterosclerosis, cardiopatía isquémica SUMMARY The majority of studies have demonstrated a correlation between diagonal earlobe creases sign with coronary artery disease and atheroscleosis. Diagonal earlobe creases run from the lower pole of the external meatus, diagonally backwards to the edge of the lobe at approximately 45. The objective of this paper is review the evidence related to this interesting clinical sign. Key words: Diagonal earlobe creases, cardiovascular disease, atheroesclerosis, ischemic cardiopathy externo, corría en ángulo de 45 grados y terminaba en el borde del lóbulo de la oreja, hallazgo denominado " signo del lóbulo hendido " (Figura 1). Figura 1. Signo del lóbulo hendido. Nótese el ángulo de 45 grados que sigue la hendidura del lóbulo, la cual se inicia en la base del conducto auditivo externo (flecha). a medicina es eminentemente clínica, independiente-mente de los avances moleculares, tecnológicos y tera-péuticos en los que se sustenta. De ahí la razón de hacer énfasis y conciencia sobre una correcta y profunda explora-ción del paciente, con la finalidad de identificar signos clínicos de diferente índole cuya correcta identificación e interpreta-ción traen consigo un adecuado y certero diagnóstico. El objetivo de este trabajo es presentar a la comunidad médica un interesante signo clínico y su interpretación, analizado a la luz de la medicina basada en evidencias. Caso clínico Hombre de 80 años de edad quien ingresó a una unidad de terapia intensiva por neumonitis intersticial. El enfermo tenía antecedentes de cardiopatía isquémica, por lo que había sido sometido a revascularización coronaria con colocación de cuatro puentes. A la exploración clínica se observó la presencia bilateral de una hendidura en el lóbulo del pabellón auricular que se iniciaba en la base del conducto auditivo L
... The results found between FDLV and epidemiological variables reinforce the correlation of cardiac adiposity with markers of cardiovascular disease risk [9,27], once the increase in cardiovascular risk is associated with the consumption of elevated alcohol levels [28][29][30][31], the presence of Frank's Sign [32,33] and smoking [34][35][36]. Recent studies suggest that smoking may have a direct association with fatty cardiac deposition [37,38]. ...
Abstract Background The human heart contains varying amounts of fat deposits. Cardiac physiological fat occurs predominantly in the right ventricle (RV). The discovery and characterization of adipose tissue along the left ventricle (LV) has been rarely reported. This study aimed to determine the occurrence of fatty deposits in epicardial, pericoronay and myocardial compartments in the LV, and to trace the epidemiological profile and clinical associations with this finding. Methods Epidemiological and morphological data and heart samples were collected from corpses submitted to necropsy. Cardiac samples were fixed, embedded in paraffin and subjected to hematoxylin-eosin for microscopic study. Results The research was based on 40 samples of cardiac tissue, 21 male cadavers and 19 female ones with mean age of 68.2 years. 52.2% of the subjects had a history of smoking, 20% of them had alcohol consumption and 43.59% showed cardiac cause as a cause of death (acute myocardial infarction – AMI – was the most frequent immediate cause of death). 82.5% of the subjects showed atherosclerotic disease in the ascending aorta (ADAA). The fat deposition in the left ventricule (FDLV) was observed in 95% of cases. Epicardial fat (EF) and pericoronary adipose tissue (PAT) are the most frequent topographies in fat accumulation in the left heart chamber and the EF deposition is associated with myocardial adiposity (MA) (Fisher test [FT] 0.019; odds ratio [OR] 0.097 [95% CI 0.033 to 0.284]; p
... Furthermore, there is no data available to assess this association in the South Asian population, which suffers from an increasingly significant burden of CAD, diabetes mellitus and hypertension. There is also a need to carry out further studies in various populations to observe this influence of ethnicity and conclude that this association is applicable to all races [4][5][6][7][8][9]. The earlobe is supplied by end arteries without a possibility of collateral circulation. ...
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.
... Since DELC was first described, various studies have demonstrated the relationship between it and coronary artery disease (CAD). [2][3][4][5] Atherosclerosis is a chronic inflammatory disease that can affect the vast majority of the arterial tree. Furthermore, atherosclerotic changes of the carotid arteries are closely related to increased cardiovascular morbidity and mortality. ...
OBJECTIVE
Atherosclerotic coronary artery diseases is one of the leading causes of death in the world. Diagonal ear lobe crease (DELC) has been recommended 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, there is no data about the relation between EAT, CIMT and DELC. In this study, we aimed to analyse this association.
METHODS
Subjects were drawn from the apparently healhty individuals who were referred to cardiology outpatient clinic. 65 subjects with DELC and 65 age and sex matched controls who do not have DELC were enrolled in the study. All subjects' EAT thickness, CIMT were measured and analysed.
RESULTS
Epicardial adipose tissue thickness was significantly higher in 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.
CONCLUSION
We have shown for the first time that, a significant and independent association between presence of DELC and increased EAT thickness, CIMT in subjects free of clinical cardiovascular diseases.
... In cross-sectional studies, ELC was associated with hypertension [8][9][10], obesity [2,8], metabolic syndrome (MS) [11], atherosclerosis [8,12], and coronary artery disease (CAD) [6,9,10,[13][14][15]. Various autopsy or biopsy studies also found an association between ELC and systemic atherosclerosis [6,[16][17][18][19] or death from CVD [20]. Further, ELC was considered an independent and early sign predisposing to CVD in several prospective studies [6,10,[21][22][23][24]. ...
Background:
Earlobe crease (ELC) has been associated with cardiovascular diseases (CVD) or risk factors (CVRF) and could be a marker predisposing to CVD. However, most studies studied only a small number of CVRF and no complete assessment of the associations between ELC and CVRF has been performed in a single study.
Methods:
Population-based study (n = 4635, 46.7% men) conducted between 2009 and 2012 in Lausanne, Switzerland.
Results:
Eight hundred six participants (17.4%) had an ELC. Presence of ELC was associated with male gender and older age. After adjusting for age and gender (and medication whenever necessary), presence of ELC was significantly (p < 0.05) associated with higher levels of body mass index (BMI) [adjusted mean ± standard error: 27.0 ± 0.2 vs. 26.02 ± 0.07 kg/m(2)], triglycerides [1.40 ± 0.03 vs. 1.36 ± 0.01 mmol/L] and insulin [8.8 ± 0.2 vs. 8.3 ± 0.1 μIU/mL]; lower levels of HDL cholesterol [1.61 ± 0.02 vs. 1.64 ± 0.01 mmol/L]; higher frequency of abdominal obesity [odds ratio and (95% confidence interval) 1.20 (1.02; 1.42)]; hypertension [1.41 (1.18; 1.67)]; diabetes [1.43 (1.15; 1.79)]; high HOMA-IR [1.19 (1.00; 1.42)]; metabolic syndrome [1.28 (1.08; 1.51)] and history of CVD [1.55 (1.21; 1.98)]. No associations were found between ELC and estimated cardiovascular risk, inflammatory or liver markers. After further adjustment on BMI, only the associations between ELC and hypertension [1.30 (1.08; 1.56)] and history of CVD [1.47 (1.14; 1.89)] remained significant. For history of CVD, further adjustment on diabetes, hypertension, total cholesterol and smoking led to similar results [1.36 (1.05; 1.77)].
Conclusion:
In this community-based sample ELC was significantly and independently associated with hypertension and history of CVD.
... An autopsy study showed that ELC was one of the strongest independent risk factor for sudden cardiac death. 24 Another follow-up study showed that a diagonal ELC is associated with increased all-cause and cardiac morbidity and mortality. Patients with ELC may be at higher risk for coronary events, even if currently without diagnostic evidence of CAD. 25 Currently, there is no studying reporting the diagnostic role of DELC in patients underwent PCI. ...
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.
... [11] In Australia, Davis et al. [12] reported that the prevalence of ELC was 55% in CAD patients. A study by Edston [3] of autopsy cases, the existence of a DELC was noted in 55%. It was found that ELC was strongly correlated with CAD in both men and women. ...
Background: The diagonal earlobe crease (ELC) has been proposed to be a marker of coronary artery disease (CAD), but this association still remains controversial. The aim of the present study was to evaluate the frequency of diagonal earlobe crease in patients with coronary artery disease.
Matherials and Methods: One hundred patients with angiographically documented CAD from Tehran Heart Center were evaluated for the presence or absence of earlobe crease. The earlobe crease was said to be present if a patient had a deep diagonal crease extending obliquely from the outer ear canal towards the border of the earlobe without discontinuity covering at least two-thirds of the ear lobe length.
Results: The prevalence of ELC was 62% (95% CI 59.7-64.6). The frequency of smoking and hyperlipidemia was significantly highr in patients with DELC (p=0.024 and p=0.001, respectively). But frequency of hypertension and diabetes were not significantly different between the two groups.
Conclusion: The frequency of diagonal earlobe crease in patients with CAD was high in our study. The data suggest that the earlobe crease sign may be a useful marker for the presence of coronary artery disease in patients.
... A minority of the studies included in the present meta-analysis looked at ELC as a marker of CAD calculating sensitivity and specificity [9,11,13,17,22,23,28,34,37,40]. In particular, the lowest sensitivity (51%) was reported in a study on 415 consecutive patients admitted to a cardiology department for coronary angiography [13]; the same study also reported the highest specificity (85%). ...
... A minority of the studies included in the present meta-analysis looked at ELC as a marker of CAD calculating sensitivity and specificity [9,11,13,17,22,23,28,34,37,40]. In particular, the lowest sensitivity (51%) was reported in a study on 415 consecutive patients admitted to a cardiology department for coronary angiography [13]; the same study also reported the highest specificity (85%). ...
... The association between the presence of an ear lobe crease (ELC) and coronary heart disease (CHD) was first reported by Frank [4] who identified diagonal creases on the ear lobes that run either unilaterally or bilaterally from the lower probe of the external auditory meatus diagonally backwards to the edge of the lobe [5]. Subsequently, several studies have demonstrated similar associations, either in patients with CHD [6][7][8] or in forensic autopsy cases [9,10]. ...
The ear has a reflexive property; therefore, various physical attributes may appear on the auricle when disorders of the internal organs or other parts of the body exist. Auricular diagnostics is an objective, painless, and noninvasive method that provides rapid access to information. Thus, the association between auricular signals and coronary heart disease (CHD) should be further investigated. A case control study was conducted to determine the predictive value of auricular signals on 100 cases of CHD (CHD+ve = 50; CHD-ve = 50) via visual inspection, electrical skin resistance measurement, and tenderness testing. The results showed that the presence of an ear lobe crease (ELC) was significantly associated with coronary heart disease. The "heart" zone of the CHD+ve group significantly exhibited higher conductivity on both ears than that of the controls. The CHD+ve group experienced significant tenderness in the "heart" region compared with those in the CHD-ve group in both acute and chronic conditions. Further studies that take into consideration the impact of age, race, and earlobe shape on ELC prevalence in a larger sample should be done.
... Lee et al 1 mathematically extrapolated the efficacy and safety outcomes of rivaroxoban within a 2-year follow up, achieved in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF), 3 to a time horizon of 35 years. 1 It is not clear that such a mathematical extrapolation could reliably reflect the behavior of rivaroxoban in the real world. Indeed, if rivaroxoban were compared to warfarin within longer follow-ups, the rate of efficacy and safety outcomes would change, altering the cost-effectiveness of rivaroxoban. ...
... A relationship between the presence of ELC and cardiovascular disease (CVD)was first reported by Frank et al. [3] . Thereafter , several clinical studies, including autopsy-based [4] and histopathological examinations [5] , confirmed that ELC is correlated with CVD [6,7]. In Korea, Park et al. [8] reported that ELC was an independent risk factor for hemorrhagic stroke. ...
Several studies found a significant association between earlobe crease (ELC) and cardiovascular disease (CVD). Metabolic syndrome (MS) is a group of high-risk factors that are a collection of cardiovascular risk factors. Scant data are available about the relationship between ELC and MS. The purpose of the current study was to examine the correlation between ELC and MS.
A cross-sectional study was performed on 3,835 subjects (1,672 females, 43.6%) aged 20 to 79 years who visited a health promotion center. To increase the reliability of the diagnosis of MS, both the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) criteria were applied. Independent association between ELC and MS was assessed using multiple logistic regression analysis after adjusting for confounding variables.
The frequency of ELC was 20.89% and the prevalence of MS was 11.03% (NCEP criteria) and 9.75% (IDF criteria). The prevalence of both ELC and MS significantly increased with age. The modified Framingham risk score was significantly higher in subjects with ELC than without. After adjusting for conventional risk factors for CVD, the risk of MS increased significantly in the presence of ELC.
The current study showed that the odds ratio for MS increased in the presence of ELC in Korean adults. ELC is an auxiliary indicator of MS, although prognostic value might be limited. Further studies are warranted to elucidate the clinical significance of ELC.
... Las mujeres con un DELC (unilateral o bilateral) tenían un riesgo de causa de muerte cardiovascular de 1,74 veces mayor que aquellas que no la presentaban. Un estudio sueco, también de autopsia forenses, de 420 hombres y 100 mujeres (edad media 56) con domicilio en Linköping, Sweden (16), demostró que el 55% tenían DELC. El aumento fue igualmente común en ambos sexos (53,8% de los hombres y el 60% de las mujeres). ...
In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodomal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient's medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk.
... Estos resultados han sido corroborados en otras publicaciones y validados en análisis de autopsia en los que se ha encontrado que la hendidura del lóbulo, sobre todo si es bilateral, se asocia con mayor grado de aterosclerosis coronaria. [10][11][12][13][14][15] Algunos autores no han confirmado la asociación entre el signo de lóbulo hendido y factores de riesgo para cardiopatía isquémica. [16][17][18] Ishii 19 demostró, con base en un análisis de regresión multivariado, que la presencia, bilateralidad y profundidad de la hendidura se relaciona con la extensión y gravedad de la aterosclerosis aórtica y coronaria. ...
The majority of studies have demonstrated a correlation between diagonal earlobe creases sign with coronary artery disease and atheroscleosis. Diagonal earlobe creases run from the lower pole of the external meatus, diagonally backwards to the edge of the lobe at approximately 45. The objective of this paper is review the evidence related to this interesting clinical sign.
Background: The association between the presence of a diagonal earlobe crease (DEC) and coronary artery disease (CAD) has been prescribed earlier. However, it is unclear whether patients with acute myocardial infarction (AMI) and DEC have a higher risk of dying.
Methods: Study participants were persons with AMI who were included in the KORA Myocardial Infarction Registry Augsburg from August 2015 to December 2016. After taking pictures of both earlobes, two employees independently assessed the severity of DEC in 4 degrees. For analysis, the expression of the DEC was dichotomized. Information on risk factors, severity and therapy of the AMI was collected by interview and from the medical record. Vital status post AMI was obtained by population registries in 2019. The relationship between DEC and survival time was determined using Cox proportional hazards models.
Results: Out of 655 participants, 442 (67.5%) showed DEC grade 2/3 and 213 (32.5%) DEC grade 0/1. Median observation period was 3.06 years (5-1577 days). During this period, 26 patients (12.2%) with DEC grade 0/1 and 92 patients (20.8%) with grade 2/3 died (hazard ratio 1.91, 95% confidence interval (CI) 1.23 - 2.96, p = 0.0037). In the fully adjusted model, patients with DEC grade 2/3 had a 1.48-fold increased risk of death compared to the DEC grade 0/1 patient group (CI 0.94 - 2.34, p = 0.0897). The fully adjusted model applied for 1-year survival revealed a significant, 2.57-fold hazard ratio of death (CI 1.07 - 6.17, p = 0.0347) for the patients with DEC grade 2/3.
Conclusions: Our results indicate that DEC is independently associated with 1-year AMI survival.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
Recibido el 09 de junio de 2013. Aceptado el 31 de agosto de 2014 RESUMEN Introducción: El Surco Diagonal del Lóbulo de la Oreja (DELC) corresponde al primer signo extracardíaco de Enfermedad Co-ronaria (EC) y se asocia con ateroesclerosis generalizada, exis-tiendo controversia en torno a su validez. Objetivos: Determinar la prevalencia del signo en la población de muy alto riesgo car-diovascular hospitalizada en un centro del área sur de Santia-go y conocer su comportamiento en relación a EC y Accidente Cerebrovascular (ACV). Método: Estudio de casos y controles. Se incluyeron 304 pacientes masculinos ≥60 años, con antece-dente de EC y hospitalizados entre mayo y diciembre de 2012 en el Hospital El Pino. Se dividieron en dos grupos evaluándose retrospectivamente la presencia/ausencia de DELC mediante fotografía. Grupo 1: sometidos a Coronariografía, con obstruc-ción significativa (≥50% estenosis) ≥1 arteria coronaria. Grupo 2: sometidos a Tomografía Computarizada de cerebro con hi-podensidad parénquima cerebral, borramiento surcos, edema cerebral, y/o hemorragia intraparenquimatosa. Se definieron como controles pacientes con resultado de intervenciones sin las lesiones definidas. Relación casos y controles 1:1. Se deter-minó la prevalencia del signo. Los resultados se ajustaron según factores de riesgo cardiovascular, mediante regresión logística condicional. Resultados: Prevalencia DELC casos (56,96%), fue mayor que controles (43,04%) (p<0,01). Odds ratio de DELC: EC = 2,79 [1,14–6,83] (p<0,03), y ACV = 2,55 [1,19–5,48] (p<0,02). Conclusión: Este estudio identificó una diferencia significativa entre la prevalencia de DELC en ambos grupos, coincidiendo los resultados de nuestra población con la literatura disponible. Se detectó asociación positiva, significativa e independiente de los factores de riesgo cardiovascular, entre DELC con EC y ACV. ABSTRACT Introduction: The Diagonal Earlobe Crease is the first extracar-diac sign of Coronary Heart Disease (CHD), associated with generalized atherosclerosis. There is controversy about its validity. Objective: Determine sign's prevalence in hospitalized population with very-high cardiovascular risk, of a medical center in the southern area of Santiago-Chile, and recognize its association with CHD and Cerebrovascular Disease (CVD). Method: Case and control study. 304 male patients, ≥60 years-old, with personal CHD medical history and hospitalized between May and December of 2012 at El Pino Hospital were included. They were divided in 2 groups, evaluating the presence/absence of DELC by photography. Group 1: submitted to coronarography with significant obstruction (≥50% stenosis) in ≥1 coronary artery. Group 2: submitted to simple brain computed tomography with hypodensity of cerebral parenchyma, effacement of sulci, brain edema and/or intraparenchymatous hemorrage. Controls were defined as patients wich result of interventions lack the described injuries. Case-Control ratio of 1:1. The sign's prevalence was determined. The results where adjusted according to cardio-vascular risk factors, by conditional logistic regression. Results: Prevalence of DELC in cases (56.96%), was higher than controls (43.04%) (p<0.01). DELC Odds Ratio: CHD = 2.79 [1.14-6.83] (p<0.03), and CVD = 2,55 [1.19–5.48] (p<0.02). Conclusion: This study identified a significative difference between prevalence in both groups, similar with the tendency described in literature. This study, also detected a significant positive association, independent of cardiovascular risk factors, between DELC with CHD and CVD.
Introduction
Transcutaneous CO 2 (PtCO 2) is a continuous and non-invasive measure recommended by scientific societies in the management of respiratory distress. The objective of this study is to evaluate the correlation between PtCO 2 and blood pressure of CO 2 (PaCO 2) by blood gas analysis in emergency patients with dyspnoea and to determine the factors that interfere in this correlation.
Methods
From January to June 2014, all patients admitted to resuscitation room of the emergency department targeted for arterial blood gases were included prospectively. A sensor measuring the PtCO 2 was attached to the ear lobe of the patient before the gas analysis. Anamnesis, clinical and laboratory parameters were identified.
Results
90 patients with dyspnoea were included (with 104 pairs of measurements), the median age was 79 years [69-85]. The correlation between PtCO 2 and PaCO 2 was R 2= 0.83 (p <0.001) but became lower for values of PaCO 2>60 mm Hg. The mean bias (±SD) between the two methods of measurement (Bland-Altman analysis) was -1.4 mm Hg (±7.7) with limits of agreement of -16.4 to 13.7 mm Hg. In univariate analysis, PaO 2 interfered in this correlation. After multivariate analysis, the temperature (OR = 3.01, 95% CI = 1.16-7.09) and the PaO 2 (OR = 1.22, 95% CI = 1.02-1.47) were found to be significant.
Conclusions
In patients admitted in emergency unit for acute respiratory failure, there is a significant correlation between PaCO 2 and PtCO 2, mainly for values below 60 mm Hg. The two limiting factors of use are hyperthermia and users training.
Certain cutaneous conditions have been reported to be associated with diabetes mellitus, insulin resistance, and metabolic syndrome. In this novel review paper, the evidence linking various cutaneous phenomena (e.g. skin tags, acanthosis nigricans, ear lobe creases, and xanthelasma) and metabolic syndrome and cardiovascular disease is examined, and explanations for these associations are proposed.
Part 1 General principles: changing spectrum of human infectious diseases host-parasite interplay role of pathology in diagnosis of infections types of tissue responses to infection microscopic detection of pathogenic organisms. Part 2 Viral infections: viral pathogenesis viral diseases of the digestive system viral skin rashes systemic and hematopoietic viral disorders adult immunodeficiency syndrome (AIDS) arboviral and zoonotic viral fevers viral encephalitis and myelitis viral myocarditis viral skin growths. Part 3 Chlamydial infections: chlamydial pathogenesis chlamydial diseases. Part 4 Rickettsial infections: rickettsial pathogenesis rickettsial diseases. Part 5 Mycoplasma infections: mycoplasma pathogenesis diseases caused by mycoplasmas. Part 6 Bacterial infections: bacterial pathogenesis diseases caused by pyogenic cocci diseases caused by common gram-negative bacteria bacterial diseases of childhood enteric bacterial diseases clostridial diseases zoonotic bacterial diseases rare gram-negative infections treponemal diseases mycobacterial diseases diseases caused by streptomycetales. Part 7 Fungal and algal infections: fungal pathogenesis superficial mycoses opportunistic mycoses endemic fungal diseases diseases caused by algae (protothecosis). Part 8 Protozoal infections: protozoal pathogenesis diseases caused by luminal protozoa diseases caused by bloodstream protozoa diseases caused by intracellular protozoa. Part 9 Helminthic infections: helminthic pathogenesis diseases caused by tissue nematodes filarial diseases diseases caused by cestodes diseases caused by trematodes. Part 10 Patients at special risk of infection: general risk categories residents and travellers in endemic areas pregnant women and neonates infants and elderly persons the poor, homeless, the addicted patients genetically predisposed immunosuppressed and leukopenic patients AIDS patients. Epilogue: the sience and art of infectious disease medicine.
The tragal pointer has long been used as a surgical landmark for the identification of the facial nerve trunk and the maxillary artery in such procedures as parotidectomy, internal fixation of subcondylar and condylar fractures, mandibular osteotomy, temporomandibular joint arthroplasty, and percutaneous blocks of branches of the trigeminal nerve and pterygopalatine ganglion. Aside from its use as an external landmark, it has also been implicated as a contributor to crease formation in the presence of peripheral arterial disease. This article will review the available literature on the tragal pointer's use as an external landmark.
Peripheral arterial disease is a severe manifestation of atherosclerosis that can lead to critical ischemia of the lower limbs and is also associated with high cardiovascular risk. Diagonal lobular and anterior tragal ear creases have been associated with coronary artery disease, but they have not yet been investigated in patients with peripheral arterial disease.
To evaluate the prevalence of ear creases among patients with peripheral arterial disease of the lower limbs, compared with patients without documented atherosclerotic disease.
Cross-sectional study including 60 male patients with peripheral arterial disease of the lower limbs and 60 dermatologic outpatients matched for age and gender. The associations were adjusted for other risk factors by conditional logistic regression.
The prevalence of diagonal and anterior tragal ear creases was higher among cases (73% vs. 25% and 80% vs. 43%, respectively) than controls; these associations remained significant even when adjusting for other known risk factors of atherosclerosis (odds ratio = 8.1 and 4.1, respectively).
Ear creases are independently associated with peripheral arterial disease and may be an external marker for risk identification.
Diagonal earlobe crease (ELC) have been proposed as a marker of generalized atherosclerosis, so in the present study it was investigated whether individuals with ELC have a shortened telomere, which correlates with an accelerated cell turnover and premature aging, leading to atherosclerosis.
The mean terminal restriction fragment (TRF) was determined by Southern blot hybridization in the peripheral blood cells of 34 male Japanese patients with metabolic syndrome (MetS) who were under 70 years of age with (n=17) and without (n=17) bilateral ELC, and assessed the relationship of ELC to atherosclerotic cardiovascular disease (AVD). The results showed that the TRF was shorter in the MetS patients with ELC in comparison to age- and risk-factor-matched MetS patients without ELC (7.6+/-1.1 kbp vs 8.6+/-1.2 kbp; P<0.05). ELC were present in 13 patients in the AVD group (n=18), but only 4 patients in the non-AVD group (n=16) had ELC (72.2% and 25% respectively; P<0.05).
These findings suggest that ELC is a useful dermatological indicator of an accelerated aging process, as suggested by excessive telomere loss, and might be a useful indirect marker of high-risk patients.
The association between the presence of diagonal earlobe crease (ELC) and coronary artery disease (CAD) still remains controversial.
The aim of this study was to evaluate the association between bilateral ELC and CAD.
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.
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%.
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.
We examined the association of dermatological signs such as baldness, thoracic hairiness, hair greying and diagonal earlobe crease with the risk of myocardial infarction in men under the age of 60 years.
A hospital-based, case-control study included 842 men admitted for the first non-fatal myocardial infarction, the controls were 712 men admitted with noncardiac diagnoses, without clinical signs of coronary disease. The relative risks were estimated as odds ratios. Logistic regression was used to control for the confounding variables.
Baldness, thoracic hairiness and earlobe crease were approximately 40% more prevalent in cases (P<10(-6) in each case). In both cases and controls, baldness and thoracic hairiness were frequently coexistent, as well as hair greying and earlobe crease (P<10(-4) in each case). After allowing for age and other established coronary risk factors, the relative risk of myocardial infarction for fronto-parietal baldness compared with no hair loss was 1.77 (95% CI 1.27-2.45) and it was 1.83 (95 CI 1.4-2.3) for men with thick, extended thoracic hairiness. The presence of a diagonal earlobe crease yielded a relative risk of 1.37 (95% CI 1.25-1.5), while hair greying was associated with myocardial infarction only in men under the age of 50 years.
It appears that baldness, thoracic hairiness and diagonal earlobe crease indicate an additional risk of myocardial infarction in men under the age of 60 years, independently of age and other established coronary risk factors.
One thousand unselected patients admitted to large urban medical centers were examined for the presence of a diagonal ear lobe crease and evaluated for the presence of coronary artery disease. A high degree of correlation between the two was seen, using both clinical and angiographic criteria for the diagnosis of coronary artery disease. The association between the ear lobe crease and coronary artery disease was independent of patient age. Prospective analysis of single risk factors in 112 consecutive patients subjected to coronary cineangiography revealed that demonstrable coronary artery disease was correlated only with the ear lobe crease and with previous acute myocardial infarction (although less strongly with the latter). These conclusions are consistent with those of the world's literature, which also finds a strong correlation between coronary artery disease and the ear lobe crease, with the exception of Oriental patients, native American Indian patients, and children with Beckwith's syndrome.
THE diagonal ear-lobe crease described below appears more commonly in patients with coronary heart disease and should be regarded as a coronary risk factor. Although other risk factors may be present in the same patient, this crease is easily noticed and serves to identify this high-risk group. Method During a three-year period from July, 1970, through June, 1973, 531 patients with acute myocardial infarction were observed in a coronary-care unit. Questionnaires were completed at the time of admission concerning the presence or absence of the diagonal ear crease, hypertension, diabetes mellitus and smoking habits. The ear crease was judged to . . .
This study evaluates the association between the presence of diagonal earlobe creases (ELC) and coronary artery disease (CAD). One thousand four hundred twenty-four patients (760 men and 664 women, aged 30 to 80 years) were examined for the presence of ELC and classified into 2 groups: group I control--1,086 consecutive patients who denied symptoms of myocardial ischemia and were admitted to a general hospital for other reasons; group II CAD--338 patients with documented CAD (presence of > or = 70% coronary diameter stenosis at angiography). ELC was present in 304 patients (28%) in group I and 220 (65%) in group II (p < 0.0001). The patients were stratified in age groups to isolate the influence of age because the prevalence of ELC and CAD increased with advancing age (p < 0.0001 for both). This association remained statistically significant in all decades, except for patients aged > 70 years. To further remove the confounding effect of different age and sex distributions between the groups, a direct adjustment of the ELC prevalence was performed. When adjusted for age and sex, the prevalence of creases was still 58% higher in patients with CAD than in control subjects (p < 0.001). The presence of ELC was also related to the extent of CAD as measured by the number of major arteries narrowed (p = 0.015). The observed sensitivity of the sign for the diagnosis of CAD was 65%, the specificity 72%, the positive predictive value 42% and the negative predictive value 87%.
An association between the ear lobe crease and coronary heart disease has been documented. A prospective study of 125 consecutive patients undergoing coronary arteriography was carried out to evaluate the ear lobe crease with the presence and extent of coronary artery disease. An ear lobe crease was observed in 65 patients, but this trait was not related to age, sex, smoking history, previous myocardial infarction, history of hypertension, family history of heart disease, body mass index or angiographically defined coronary artery disease. We conclude the ear lobe crease is not related to coronary heart disease.
In several clinical studies, the diagonal earlobe crease has been statistically related to the presence of ischemic heart disease. Only one study of a relatively small number of hospitalized patients attempts to relate the earlobe crease with amount of stenotic coronary atherosclerosis demonstrated at necropsy. We examined the relationship between the degree of coronary atherosclerosis and the presence of a diagonal earlobe crease in 800 consecutive autopsies performed for medicolegal reasons and thus including a wide spectrum of subjects. Statistical analysis by the chi 2 test demonstrated a positive correlation (p less than 0.01) between the presence of the diagonal earlobe crease and obstructive coronary atherosclerosis narrowing on at least one major coronary artery greater than 75%. We conclude that the autopsy findings support the clinical observations that the diagonal earlobe crease is a cutaneous sign of obstructive coronary atherosclerosis and that the sign should be used accordingly.
Several studies had indicated that the earlobe crease may be a marker of coronary artery disease (CAD). This prospective study of 261 consecutive men undergoing coronary arteriography was carried out to evaluate the association of the earlobe crease with the presence and extent of CAD. A positive earlobe crease was detected in 67% of this population. When examining the presence of CAD in men with (n = 175) and without (n = 86) an earlobe crease, 85% of those with and 85% of those without an earlobe crease showed some degree of CAD. Since the prevalence of an earlobe crease increased with advancing age, we examined the age-specific prevalence rates of CAD in men with and without an earlobe crease and found no significant differences in those rates. A similar lack of association between earlobe crease and CAD was seen when we simultaneously controlled for other potentially confounding factors. We conclude that the reported association between earlobe crease and CAD is due to the fact that the prevalence of earlobe crease and CAD each increase with age.
The diagonal earlobe crease (ELC) has been found to be associated with atherosclerotic heart disease. Although atherosclerotic cardiovascular disease is less prevalent among women than among men, no studies have been reported for women on the possible relationship of reproductive factors, contraceptive and menopausal estrogen use, and alcohol use on the expression of the ELC.
The presence of ELC was determined in 625 white women who were seen as part of a breast research project. Information was obtained on age, height, weight, age at menarche, parity, age at first full-term pregnancy, use of oral contraceptives or menopausal estrogens, alcohol consumption, and smoking. Statistical methods used included estimation of the age-adjusted odds ratios and their 95% confidence intervals, and multiple logistic regression.
No association was found between the ELC and reproductive factors and smoking. Only age, Quetelet index, and alcohol use were associated with the ELC. The ELC was negatively associated with alcohol use, and was more marked in women under 59 years of age. The positive association of ELC with the Quetelet index progressively became more marked with advancing age, especially after 60 years of age.
The negative association found between the ELC and alcohol use is of interest because of the reported protective effect of moderate alcohol consumption on risk of coronary heart disease. No significant association was found between the ELC and reproductive risk factors. Based on events occurring during the embryonic development of the earlobes, a new hypothesis is proposed for the formation and peculiar diagonal localization of the ELC in adult earlobes in association with atherosclerotic vascular disease.
To determine whether high-risk patients with unilateral, bilateral, or no earlobe creases (ELC) have different prognoses for common sequelae of coronary heart disease.
Two hundred sixty-four consecutive patients from a university-based coronary care unit or catheterization laboratory were blindly followed up for 10 years, using questionnaires, medical records, and death certificates. The primary outcome measure was time to cardiac event; namely, coronary artery bypass graft (CABG), myocardial infarction (MI), or cardiac death. Analyses included log-rank tests and Cox proportional hazards regression modelling.
The number of creased ears was significantly associated, in a graded fashion, with 10-year cardiac event free survival: 43.5% +/- 5.7%, 33.0% +/- 6.7%, or 17.5% +/- 4.6% (mean +/- standard error for 0, 1 or 2 ELC, respectively; P = 0.003). After adjustment for 10 known cardiac risk factors, including age and left ventricular ejection fraction, the relative risk for a cardiac event for a unilateral ELC, relative to 0 ELC, was 1.33 (95% confidence interval [CI] 1.10 to 1.61, P = 0.02), and for bilateral ELC, it was 1.77 (95% CI 1.21 to 2.59, P = 0.003).
Ear lobe creases are associated, in a graded fashion, with higher rates of cardiac events in patients admitted to hospital with suspected coronary disease. In such patients, ELC may help to identify those at higher risk for sequelae for coronary disease.
The rate of cardiac deaths that are sudden is approximately 50%, and decreases with age. The causes of sudden cardiac death are diverse, and are a function of age. In children and adolescents, coronary anomalies, hypertrophic cardiomyopathy and myocarditis are frequent substrates for lethal arrhythmias; in adults, coronary atherosclerosis and acquired forms of cardiomyopathy are the most common findings at autopsies of sudden cardiac death. This review focuses on coronary causes of sudden cardiac death, especially congenital coronary artery anomalies, which result in sudden death almost exclusively in adults younger than age 35, and coronary thrombosis. The most lethal coronary artery anomaly is the left coronary artery arising from the right sinus of Valsalva; this anomaly often results in fatal arrhythmias, often with exercise. The right coronary artery arising from the left sinus of Valsalva may also be lethal in adolescents and young adults, but, unlike the anomalous left, is more often an incidental finding at autopsy. Approximately 60% of sudden coronary death is caused by coronary thrombosis, the rest die with severe coronary disease in the absence of thrombosis. The two major substrates of coronary thrombosis are plaque rupture and plaque erosion, and are not only different pathologically, but are seen in patients with divergent risk factor profiles. Plaque rupture is the most common cause of fatal coronary thrombus, and is characterized by necrotic core with a thin fibrous cap, infiltrated by macrophages. The factors that result in plaque instability and rupture are largely unknown, and are under intense scrutiny; morphologic studies have identified serum lipid abnormalities as a key risk factor in the development of plaque rupture. Plaque erosion, in contrast to plaque rupture, is seen in younger men and women, is not associated with lipid abnormalities, and does not result from exposure of the lipid core to the lumen. The heterogeneity of the atherosclerotic plaque and the diverse mechanics of plaque progression and thrombosis have only been relatively recently explored, and are largely elucidated by autopsy studies of victims of sudden coronary death.