Maladies cardiovasculaires et diagnostic

The Forgotten Clinical Sign: The Use of Diagonal Earlobe Crease in the Detection of Coronary Artery Disease

Abstract

Amoateng R, Choi J and Caplice N

Objective: Investigate the association of diagonal earlobe crease (DELC) and coronary artery disease (CAD) in men under 60.

Design: A prospective case-control study.

Setting: Male patients aged 60 and under, admitted to cardiology wards at Cork University Hospital.

Participants: 94 male patients were recruited from January 2018 to January 2019. 45 patients acutely presenting at the cardiology wards with an acute coronary syndrome event were included in the study. 49 patients without a history of CAD on the same wards were used as controls. Patients with visible trauma to the earlobe were excluded from the study.

Interventions: Subjects’ earlobes were inspected for the presence or absence of DELC and images were captured to be reviewed by two blinded observers.

Primary and secondary outcome measures: Primary goal was to establish the prevalence of DELC among male cardiac patients under 60. Secondary goal was to investigate the association of DELC with the traditional risk factors: smoking, hypertension, dyslipidaemia, diabetes.

Results: Mean age (in years) of patients with DELC was 51.9 ± 7.33 (p<0.015). The prevalence of DELC among cardiac patients was 80% compared to 51% in the control group (p<0.003). Sensitivity and specificity of DELC to detect CAD was 80% and 49.0% and an odds ratio of 3.84 (95% confidence interval of 1.53-9.64, p<0.001). DELC was independently associated with CAD (p<0.001). Smoking history was associated with DELC (p<0.046). Hypertension, dyslipidaemia and diabetes were not associated with DELC (p<0.241, p<0.478, p=1.000 respectively).

Conclusion: DELC was independently associated CAD and smoking history. DELC could be used as a simple clinical tool to risk-stratify patients for CAD.