The Pleating Effect Explains the Cardioauricular Connection

Unified Anatomical Explanation of Diagonal Earlobe Creases, Preauricular Creases, and Paired Creases of the Helix

Three types of ear creases have been described in the medical literature in association with several cardiovascular and metabolic disorders: diagonal earlobe creases (DELCs) (Frank’s sign), preauricular vertical creases, and paired ear creases of the helix (PECH). The exact mechanism of development of such creases, as well as an explanation of their association with cardiometabolic disorders, remains unclear. Herein, the author provides a suggested unified mechanism of development of all three types of auricular creases. In addition, an anatomical explanation linking the associated cardiometabolic disorders and the three types of ear creases to the common culprit of facial visceral adiposity will be given.

Patients with Earlobe Crease May Associate with Lower Concentration of the Age-Suppressing Hormone Klotho

Objective

Earlobe crease (ELC) has been considered as a skin sign of atherosclerosis, and its pathophysiological mechanism is still unclear. Our study aims to test the hypothesis that ELC patients with lower serum levels of the age-suppressing hormone Klotho, which is not only associated with premature aging but also with endothelial dysfunction, may be associated with atherosclerosis.

Methods

A total of 135 patients aged 40–68 years underwent coronary angiography. According to the presence or absence of coronary heart disease (CAD) and ELC, they were divided into three groups: CAD group and ELC group (ELC group, n = 45); no ELC group (non-ELC group, n = 45). There was no ELC or CAD in the control group (control group, n = 45). Serum Klotho concentration was obtained by enzyme-linked immunosorbent assay (ELISA).

Results

The Klotho level in the ELC group was 365.6 ± 38.1 pg/mL, while the Klotho level in the non-ELC group was 568.8 ± 44.9 pg/mL. It is worth noting that the Klotho level of the ELC group was significantly lower than that of the non-ELC group (P < 0.001). The serum Klotho level of the control group was higher than that of the non-ELC group (593.3±45.3 vs 568.8±44.9 pg/mL, P = 0.702), but the difference was not statistically significant. Multiple logistic regression analysis showed that the Klotho level is a parameter that affects the appearance of ELC.

Conclusion

Serum Klotho levels were considerably lower in patients with ELC. We concluded that the perturbations of Klotho in patients might be associated with ELC and with CAD.

Frank's sign and paired ear creases of the helix : Current concepts of significance for morbidity

Frank's sign (FS) was described in 1973 as an auricular marker for cardiovascular disease presenting as a crease of the auricular lobule. Since its first clinical description, there have been multiple studies underlining the role of FS in a myriad of conditions, such as atherosclerosis, hypertension, cerebrovascular disease, peripheral artery disease, metabolic diseases as well as studies looking at physiological differences in the auricular shape that may mimic FS; however, a complex study to comprehensively analyze the clinical, gross, and histological findings of patients with FS has not yet been performed. Most studies focused on a specific system, mechanism of disease entry. This short review tries to summarize the current knowledge of FS in relation to diseases as well as its clinical classification, histology, and association with the recently described paired ear creases of the helix, as an attempt to reveal the dubious role of FS as a possible prognostic and predictive marker.

Sideburns Obesity Syndrome: Is Sideburn Fat the Window to the Heart?

Despite significant advancements in cardiovascular diagnostic technology, physical examination signs remain credible diagnostic indicators of coronary artery disease. Here, we report a case of a 50-year-old male patient with premature coronary artery disease associated with a novel physical sign of bilateral symmetrical bulging of the sideburn areas of the face. The sideburns correspond anatomically to the buccal fat pad which is composed of visceral adipose tissue. Visceral obesity is an established risk factor for cardiovascular disease, independent of total body weight, with some suggestion of a causal association. Therefore, isolated buccal visceral obesity (sideburn obesity syndrome) could be a marker for premature coronary artery disease.