title: Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography.
abstract: 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.
authors.affiliation: Department of Medicine and Imaging, Heart Institute, Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA. haim.shmilovich@gmail.com
authors.forename: Haim
authors.initials: H
authors.lastname: Shmilovich
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Cheng
authors.forename: Ronak
authors.initials: R
authors.lastname: Rajani
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.forename: Balaji K
authors.initials: BK
authors.lastname: Tamarappoo
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakazato
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Smith
authors.forename: Yuka
authors.initials: Y
authors.lastname: Otaki
authors.forename: Rine
authors.initials: R
authors.lastname: Nakanishi
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.forename: William
authors.initials: W
authors.lastname: Paz
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Pimentel
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Louise E J
authors.initials: LE
authors.lastname: Thomson
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D054644:Ear Auricle / Q000033:anatomy & histology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*