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Karch J, Raja A, De La Garza H, De Jesus Diaz Zepeda A, Shih A, Maymone MBC, Phillips TJ, Secemsky E, Vashi N. Part I: Cutaneous manifestations of cardiovascular disease. J Am Acad Dermatol 2023; 89:197-208. [PMID: 35504486 DOI: 10.1016/j.jaad.2021.06.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
In this part 1 of a 2-part continuing medical education series, we review the epidemiology and pathophysiology of cardiovascular disease, its association with cutaneous symptoms, and the diagnosis and evaluation of cutaneous features of cardiovascular syndromes, including infective endocarditis, acute rheumatic fever, Kawasaki disease, cholesterol embolization syndrome, lipid disorders, cardiac amyloidosis, and cardiac myxomas. As the incidence and prevalence of cardiovascular diseases increase, dermatologists play an essential role in recognizing the cutaneous manifestations of cardiovascular diseases in order to appropriately connect patients with follow-up care.
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Affiliation(s)
- Jamie Karch
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aishwarya Raja
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Henriette De La Garza
- Departments of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Allen Shih
- Departments of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mayra B C Maymone
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tania J Phillips
- Departments of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Eric Secemsky
- Smith Center for Outcomes Research, Departments of Cardiology and Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Neelam Vashi
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Dermatology, US Department of Veteran Affairs, Boston Health Care System, Boston, Massachusetts.
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Ogan N, Gunay E, Ekici B, Baha A, Gulensoy ES, Akpinar EE, Yuksel A. Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign. Heart Lung 2020; 49:331-335. [PMID: 32061412 DOI: 10.1016/j.hrtlng.2020.01.008] [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] [Received: 10/31/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Cardiovascular diseases are the most common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Literature indicates that there may be a relationship between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Accordingly, the present study aimed to assess the relationship with DELC and cardiac comorbidities in patients with COPD during routine physical examination. MATERIALS AND METHODS In this prospective cohort study, we evaluated the demographic data, pulmonary function test (PFT) results, lipid profile, oxygen saturation, and the presence of DELC in patients with COPD and control subjects. RESULTS DELC was diagnosed in 155 (62%) of COPD patients and these patients had a higher prevalence of CAD (p = 0.044). Moreover, DELC was diagnosed in 135 men (68.5%) and 20 (37.7%) women in the COPD group (p<0.001) and in 39 (48.8%) men and 14 (56.0%) women in the control group (p = 0.527). On the other hand, CAD was diagnosed in 18% of patients with early-stage COPD (n = 104) and in 30.8% of patients with late-stage COPD (n = 146) (p = 0.041). The sensitivity and specificity of DELC positivity in predicting CAD were 80.65% and 44.15% in COPD patients, respectively. CONCLUSION The presence of cardiac comorbidities in COPD patients may play a vital role in the severity of the disease, exacerbations, and may also reduce the treatment response. Accordingly, an earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity.
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Affiliation(s)
- Nalan Ogan
- Ufuk University Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey.
| | - Ersin Gunay
- Afyon Kocatepe Faculty of Medicine, Department of Chest Diseases, Afyonkarahisar, Turkey
| | - Berkay Ekici
- Ufuk University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Ayse Baha
- Kyrenia Akcicek National Hospital, Department of Chest Diseases, Kyrenia, Cyprus
| | - Esen Sayin Gulensoy
- Ufuk University Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - E Eylem Akpinar
- Ufuk University Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Aycan Yuksel
- Ufuk University Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
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Bawaskar HS, Bawaskar PH, Bawaskar PH. Diagonal ear lobe crease: A premonitory diagnostic sign of impeding ischemic heart disease. J Family Med Prim Care 2018; 7:1361-1367. [PMID: 30613525 PMCID: PMC6293914 DOI: 10.4103/jfmpc.jfmpc_181_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: In India, significant number of individuals suffers from ischemic heart disease (IHD). Majority of chest pain victim initially report to his family physician. At times, sudden death is the first and last manifestation of IHD. Doctors are aware of various risk factors for IHD. The diagonal ear lobe crease (DELC) has been characterized in medical literature as a surrogate marker which can be easily identified as high-risk case for impending IHD. We report here the incidence of IHD accompanied with DELC in rural population. Patients and Methods: Eight hindered and eighty eight patients attended to general physician Mahad during January 2012 to December 2015 with complaints of chest pain were investigated for presence of DELC. Presence of DELC was correlated to varies risk factors including hypertension, hyperlipidemia, diabetes mellitus (DM), body mass index (BMI), occipital baldness, and tobacco consumption. Results: Out of patients studied, 645 (72.6%) had hypertension, 508 (57.2%) had DELC, of these 486 (95%) suffered from IHD, 246 (48%) had DM, 246 (48%) had occipital baldness, and 325 (64%) had hyperlipidemia. Significant association between BMI > 25+ in male >50 years old with odd ratio 2.08 (95% CI: 1.27–3.39; P = 0.003). Interpretation: Presence of DELC with or without risk factors is a simple clinical observation easily noted during examination by family physician to investigate and to rule out IHD.
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Affiliation(s)
| | - Parag Himmatrao Bawaskar
- Department of Cardiology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
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Kamal R, Kausar K, Qavi AH, Minto MH, Ilyas F, Assad S, Shah SU. Diagonal Earlobe Crease as a Significant Marker for Coronary Artery Disease: A Case-control Study. Cureus 2017; 9:e1013. [PMID: 28331775 PMCID: PMC5338988 DOI: 10.7759/cureus.1013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Rida Kamal
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Komal Kausar
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Ahmed H Qavi
- Department of Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY, USA
| | - Moeed H Minto
- Department of Medicine, Eastbourne District General Hospital, UK
| | - Fariha Ilyas
- Department of Medicine, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - Salman Assad
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Saeed U Shah
- Department of Cardiology, Shifa College of Medicine, Islamabad, Pakistan
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Borba DL, Hipólito UV, Pereira YCL. Early diagnosis of atherosclerosis with panoramic radiographs: a review. J Vasc Bras 2016; 15:302-307. [PMID: 29930608 PMCID: PMC5829729 DOI: 10.1590/1677-5449.002316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Carotid artery disease has been linked with cerebral vascular accident, also known as stroke, cerebral hemorrhage, or cerebral ischemia. It is caused by narrowing or obstruction of arteries in the neck (the carotid arteries) that are responsible for transporting blood from the aorta to the brain. Panoramic radiographs are used in dentistry to show both dental arches as a supplement to the clinical dental examination. The objective of this study is to highlight the importance of panoramic radiographs for diagnosis of arterial disease, by means of a bibliographic review. The PubMed database was searched using the keywords “atherosclerosis” and “panoramic”, with the filters “last 5 years” and “humans”. Twenty articles were identified, six of which were chosen for this study because they were open access. The review concluded that panoramic radiographs enable early diagnosis of carotid artery calcification, resulting in earlier interventions, and offer an accessible cost.
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Affiliation(s)
- Daiane Landim Borba
- Faculdade de Ciências do Tocantins - FACIT, Curso de Odontologia, Araguaína, TO, Brazil
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Wang Y, Mao LH, Jia EZ, Li ZY, Ding XQ, Ge PC, Liu Z, Zhu TB, Wang LS, Li CJ, Ma WZ, Yang ZJ. Relationship between diagonal earlobe creases and coronary artery disease as determined via angiography. BMJ Open 2016; 6:e008558. [PMID: 26868940 PMCID: PMC4762085 DOI: 10.1136/bmjopen-2015-008558] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study was designed to examine the prevalence of unilateral and bilateral diagonal earlobe creases (DELCs) with respect to the diagnosis of coronary heart disease (CHD). METHODS A total of 558 consecutive participants (402 males and 156 females) aged 36-91 years who underwent coronary angiography were enrolled in this study. The participants were classified as being without a DELC, having a unilateral DELC and having bilateral DELCs; participants with either a unilateral DELC or bilateral DELCs were defined as participants with DELCs. Significant CHD was defined as at least one major vessel with >50% stenosis, and coronary atherosclerosis severity was defined using the Gensini scoring system. RESULTS In the present study, bilateral DELCs were more frequently among male (p=0.001), CHD (p=0.000), older people (p=0.000) and those with more severe coronary artery atherosclerosis (p=0.000). The results of the multiple regression analyses indicated that DELCs (OR, 4.861; 95% CI 3.093 to 7.642, p=0.000) remained independently associated with a risk of CHD. It was assumed that participants without a DELC have a certain background risk for CHD (OR is assumed to be 1); the results of the multivariate logistic regression indicated that the relative risk of CHD among participants with bilateral DELCs was 5.690 among all participants (OR, 5.690; 95% CI 3.450 to 9.384, p=0.000), 5.436 among male participants (OR, 5.436; 95% CI 2.808 to 10.523, p=0.000) and 7.148 among female participants (OR, 7.148; 95% CI 3.184 to 16.049, p=0.000). Moreover, a positive association between DELC and age (SI=1.21, SIM=1.65, AP =0.132), gender (SI=2.09, SIM=0.81, AP=0.49) and smoking status (SI=1.49, SIM=0.73, AP=0.29) was found, respectively. CONCLUSIONS The results of the present study indicated that DELCs are a simple and a feasible means of identifying CHD. However, the exact mechanism underlying the relationship between DELCs and CHD warrants further study.
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Affiliation(s)
- Yong Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Cardiovascular Medicine, The People's Hospital of Gaochun, Nanjing, Jiangsu Province, China
| | - Li-Hua Mao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Department of Cardiovascular Medicine, The Jurong City Hospital of Traditional Chinese Medicine, Zhenjiang, Jiangsu Province, China
| | - En-Zhi Jia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhao-Yang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiao-Qing Ding
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Peng-Cheng Ge
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhe Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Tie-Bing Zhu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lian-Sheng Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Chun-Jian Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wen-Zhu Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhi-Jian Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Agouridis AP, Elisaf MS, Nair DR, Mikhailidis DP. Ear lobe crease: a marker of coronary artery disease? Arch Med Sci 2015; 11:1145-55. [PMID: 26788075 PMCID: PMC4697048 DOI: 10.5114/aoms.2015.56340] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/25/2014] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Aris P. Agouridis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free London Foundation Trust, Pond Street, London, UK
| | - Moses S. Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Devaki R. Nair
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free London Foundation Trust, Pond Street, London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Abecasis P, Chimenos-Küstner E, López-López O. Orthopantomography contribution to prevent isquemic stroke. J Clin Exp Dent 2014; 6:e127-31. [PMID: 24790711 PMCID: PMC4002341 DOI: 10.4317/jced.51352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/26/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The ortopantomography (OPG) can be a valuable way for an early detection of calcified atheroma plaques, thus contributing for a preliminary stroke risk evaluation. The study looks for the existence of calcified atheroma plates through the use of OPG, comparing the results with the stenosis percentage found through eco-doppler. It has been analyzed the correlation of the number of years as a smoker, arterial hypertension and body mass index, against the risk of having calcified atheroma plaques. STUDY DESIGN Observational, transversal and prospective study with 84 patients from the Dental Center of Hospital Particular de Lisboa. First the patients answered to an inquiry and them they were submitted to an OPG and an eco-doppler. RESULTS AND CONCLUSIONS It is possible to detect calcified atheroma plaques in the carotid artery through an OPG and patients who have them have got a fifteen fold greater risk of suffering from carotid stenosis. In this study, it has been confirmed the increase in carotid stenosis for long term smokers (OR = 1,033, n=18, 42,9%). The study results show that hypertension patients have a probability 5,426 greater than normal of developing atheroma plaques (with sig=0,049). Amid analyzed patients, the correlation between obesity and the existence of carotid atheroma plaques was significant, although negative (sig=0,047). OPG can help find patients with higher risk of isquemic stroke. Key words:Orthopantomography, Stroke, Carotid disease, Calcified atheroma.
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Affiliation(s)
- Pedro Abecasis
- Phd in Odontology. Profesor of Oral radiology in ISC-Egas Moniz. University of Odontology, Portugal
| | - Eduardo Chimenos-Küstner
- Phd in Medicine and Surgery. Profesor Oral Medicine, Facultad de Odontología, Universidad de Barcelona
| | - Osé López-López
- Phd in Medicine and Surgery. Profesor Oral Medicine, Facultad de Odontología, Universidad de Barcelona
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Lucenteforte E, Romoli M, Zagli G, Gensini GF, Mugelli A, Vannacci A. Ear lobe crease as a marker of coronary artery disease: a meta-analysis. Int J Cardiol 2014; 175:171-5. [PMID: 24866080 DOI: 10.1016/j.ijcard.2014.04.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ersilia Lucenteforte
- NEUROFARBA, Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, Center for Integrative Medicine, Florence University, Careggi General Hospital, Florence, Italy
| | - Marco Romoli
- Florence University, Careggi General Hospital, Florence, Italy
| | - Giovanni Zagli
- Anaesthesiology Unit, Florence University, Careggi General Hospital, Florence, Italy
| | - Gian Franco Gensini
- Department of Critical Care Medicine and Surgery, Florence University, Careggi General Hospital, Florence, Italy
| | - Alessandro Mugelli
- NEUROFARBA, Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, Center for Integrative Medicine, Florence University, Careggi General Hospital, Florence, Italy
| | - Alfredo Vannacci
- NEUROFARBA, Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, Center for Integrative Medicine, Florence University, Careggi General Hospital, Florence, Italy.
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Wu XL, Yang DY, Zhao YS, Chai WH, Jin ML. Diagonal earlobe crease and coronary artery disease in a Chinese population. BMC Cardiovasc Disord 2014; 14:43. [PMID: 24708687 PMCID: PMC3994203 DOI: 10.1186/1471-2261-14-43] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/29/2014] [Indexed: 11/17/2022] Open
Abstract
Background Many reports have claimed associations between diagonal earlobe crease (DELC) and coronary artery disease (CAD), but data in Chinese populations are limited. Methods 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. Results 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). Conclusions The study showed a significant association between DELC and CAD independent of established risk factors in Chinese.
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Affiliation(s)
- Xing-Li Wu
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
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