Coronary artery disease
Relation of Diagonal Ear Lobe Crease to the Presence, Extent, and Severity of Coronary Artery Disease Determined by Coronary Computed Tomography Angiography

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Controversy exists concerning the relation between diagonal ear lobe crease (DELC) and coronary artery disease (CAD). We examined whether DELC is associated with CAD using coronary computed tomography (CT) angiography. We studied 430 consecutive patients without a history of coronary artery intervention who underwent CT angiography on a dual-source scanner. Presence of DELC was agreed by 2 blinded observers. Two blinded readers evaluated CT angiography images for presence of CAD and for significant CAD (≥50% stenosis). Chi-square and t tests were used to assess demographic differences between subgroups with and without DELC and the relation of DELC to 4 measurements of CAD: any CAD, significant CAD, multivessel disease (cutoff ≥2), and number of segments with plaque (cutoff ≥3). Multivariable logistic regression was performed to adjust for CAD confounders: age, gender, symptoms, and CAD risk factors. Mean age was 61 ± 13 and 61% were men. DELC was found in 71%, any CAD in 71%, and significant CAD in 17% of patients. After adjusting for confounders, DELC remained a significant predictor of all 4 measurements of CAD (odds ratio 1.8 to 3.3, p = 0.002 to 0.017). Sensitivity, specificity, and positive and negative predictive values for DELC in detecting any CAD were 78%, 43%, 77%, and 45%. Test accuracy was calculated at 67%. Area under the receiver operator characteristic curve was 61% (p = 0.001). In conclusion, in this study of patients imaged with CT angiography, finding DELC was independently and significantly associated with increased prevalence, extent, and severity of CAD.

Section snippets

Methods

We studied 459 consecutive patients who underwent CT angiography during a 9-month period in 1 medical center. After excluding those with previous coronary artery bypass surgery (n = 23), previous coronary artery stenting (n = 2), or an uninterpretable scan (n = 4), 430 patients formed the study population in which 52% were white, 22% were Hispanic, 10% were Asian, 8% were African-American, and 8% did not respond the question about ethnicity. Indications for undergoing CT angiography were chest

Results

Demographic characteristics of the 430 participants are presented in Table 1. Prevalence of any CAD was 71% and that of significant CAD was 17%. Prevalence of DELC was 71%. Overall interobserver agreement for presence of DELC was 97.4%. There was no difference in prevalence of any chest pain between patients with and without DELC (47% vs 46%, p = 0.844).

Patients with DELC were significantly older (64 ± 12 vs 53 ± 13 years, p <0.001) and had a significantly higher prevalence of hypertension (61%

Discussion

In this cohort of consecutive patients, we found that DELC was independently and significantly associated with the presence, extent, and severity of CAD and had a trend as an additive value above them. We studied coronary arteries using CT angiography, a validated robust tool for noninvasive diagnosis of coronary artery plaque and stenosis, and provide the first report that DELC is associated with the presence, extent, and severity of CAD. Importantly, DELC remained associated with the

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    Dr. Shmilovich is a fellow of Save a Heart Foundation, Los Angeles, California and receives a fellowship grant from the American Physician Fellowship for Medicine in Israel, Boston, Massachusetts.

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