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Sekiguchi A, Inoue Y, Yamazaki S, Uchiyama A, Ishikawa O, Kuribayashi S, Uraoka T, Hara K, Yamaguchi K, Maeno T, Uchida M, Koyama H, Motegi SI. Prevalence and clinical characteristics of earlobe crease in systemic sclerosis: Possible association with vascular dysfunction. J Dermatol 2020; 47:870-875. [PMID: 32424835 DOI: 10.1111/1346-8138.15400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
Patients with systemic sclerosis (SSc) develop various vasculopathy-induced vascular disorders such as Raynaud's phenomenon, abnormal nail-fold capillaries, persistent digital ischemia, digital ulcers (DU), and sometimes develop renal crisis and pulmonary artery hypertension (PAH), affecting prognosis. Earlobe crease (ELC), also known as Frank's sign, is a wrinkle extending from the tragus to the outer border of the earlobe and is generally recognized as the sign of cardiovascular events. However, no previous study analyzed the association between ELC and SSc. In this study, we examined the prevalence and clinical characteristics of ELC in SSc patients. We analyzed 145 Japanese SSc patients and found that the prevalence of ELC in SSc patients was 23.4% (43/145), similar to that previously reported in the general population without SSc. Using univariate analysis, we found that SSc patients with ELC were characterized by old age, high incidence of DU, ILD and PAH, and high complication of coronary artery diseases (CAD) compared with SSc patients without ELC. In multivariate analysis, ELC was significantly associated with old age and incidence of DU. PAH tended to correlate with ELC without statistical significance. These results suggest that ELC may be associated with vascular disorders in SSc patients. This is the first report concerning the prevalence and clinical characteristics of ELC in patients with SSc. ELC is very easy to detect in clinical practice and helps physicians to identify SSc patients at risk of developing vascular disorders such as DU and PAH.
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Affiliation(s)
- Akiko Sekiguchi
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuta Inoue
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sahori Yamazaki
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Uchiyama
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Ishikawa
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shiko Kuribayashi
- Department of, Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshio Uraoka
- Department of, Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenichiro Hara
- Department of, Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouichi Yamaguchi
- Department of, Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshitaka Maeno
- Department of, Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mitsuo Uchida
- Department of, Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Koyama
- Department of, Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sei-Ichiro Motegi
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Kul S, Konus AH, Dursun I, Turan T, Cirakoglu OF, Sahin S, Karal H, Akyuz AR. Anterior Tragal Crease Is Associated With SYNTAX Score in Non-ST-Segment Elevation Myocardial Infarction. Angiology 2020; 71:793-798. [PMID: 32347104 DOI: 10.1177/0003319720920143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The main aim of this study was to investigate the relation between anterior tragal crease (ATC) and coronary artery lesion complexity and severity assessed using the SYNTAX score (SXscore) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total of 121 patients with a first-time diagnosis of NSTEMI were consecutively enrolled. ATC was defined as ≥1 crease that was close to the tragus and descended anteriorly. SXscore was calculated using the SXscore algorithm. The SXscore was higher in the ATC-positive group than in the ATC-negative group (11.85 ± 8.20 vs 7.52 ± 6.38, P = .003). In the univariate analysis, hemoglobin (male: 11.7-17.4 g/dL, female: 11.7-16.1 g/dL; P = .006), diabetes mellitus (P = .031), current smoking (P = .022), and presence of ATC (P = .022) were significantly associated with increased SXscore. Multivariate analysis revealed ATC (95% confidence interval [CI]: 1.313-7.800, P = .011), current smoking (95% CI: 2.034-13.893, P = .001), and hemoglobin (95% CI: 0.433-0.822, P = .002) as independent determinants of increased SXscore. Anterior tragal crease is easily detected by physical examination. Presence of ATC in patients with NSTEMI may be a warning signal of complexity and severity of coronary artery disease (CAD).
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Affiliation(s)
- Selim Kul
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ali Hakan Konus
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ihsan Dursun
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Turhan Turan
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Omer Faruk Cirakoglu
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Sinan Sahin
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Huseyin Karal
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ali Riza Akyuz
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
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Pacei F, Bersano A, Brigo F, Reggiani S, Nardone R. Diagonal earlobe crease (Frank's sign) and increased risk of cerebrovascular diseases: review of the literature and implications for clinical practice. Neurol Sci 2019; 41:257-262. [PMID: 31641899 DOI: 10.1007/s10072-019-04080-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Federico Pacei
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Anna Bersano
- Division Cerebrovascular Disease Unit, IRCCS Foundation "C. Besta", Neurological Institute, Milan, Italy
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy.,Division of Neurology, Franz Tappeiner Hospital, Via Rossini, 5, 39012, Merano, BZ, Italy
| | - Stefano Reggiani
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Raffaele Nardone
- Division of Neurology, Franz Tappeiner Hospital, Via Rossini, 5, 39012, Merano, BZ, Italy. .,Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
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Abstract
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.
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Affiliation(s)
- Saleh Nazzal
- From the Department of Medicine, Baruch Padeh Poria Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Arnon Blum
- From the Department of Medicine, Baruch Padeh Poria Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Israel
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