title: Incremental value of diagonal earlobe crease to the Diamond-Forrester classification in estimating the probability of significant coronary artery disease determined by computed tomographic angiography.
abstract: The Diamond-Forrester (DF) algorithm overestimates the likelihood of significant coronary artery disease (≥50% stenosis, CAD50). The aim of the present study was to evaluate whether the addition of a diagonal earlobe crease (DELC) enhances the predictive ability of DF to detect CAD50 by coronary computed tomographic angiography (CTA). We evaluated 430 patients referred for CTA for symptoms, cardiovascular risk factors, and CAD50 likelihood using DF. Observers blinded to CTA findings evaluated the presence of DELC. The diagnostic accuracy and relation of DF, DELC, and DF + DELC for predicting CAD50 in patients with chest pain were evaluated using receiver operating characteristics curve (area under curve) analyses and multivariate logistic regression analyses. In 199 patients with chest pain, the sensitivity and specificity for CAD50 were 96% and 20% for DF (AUC 0.59, p = 0.59), 91% and 32% for DELC (AUC 0.62, p = 0.03), and 91% and 41% for DF + DELC (AUC 0.66, p = 0.004). On multivariate analyses DELC was the only independent predictor of CAD50 (odds ratio 3.6, 95% confidence interval 1 to 12.9, p = 0.048). DF + DELC increased the predictive ability to detect CAD50 above cardiovascular risk factors (odds ratio 5.6, 95% confidence interval 1.6 to 19.8, p = 0.007). In patients with chest pain, the presence of DELC is related to CAD50 beyond DF. A combined variable of DF + DELC provides superior discriminatory ability for detecting CAD50 than either method alone.
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. Electronic address: haim.shmilovich@gmail.com.
authors.forename: Haim
authors.initials: H
authors.lastname: Shmilovich
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakazato
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Smith
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Otaki
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Rine
authors.initials: R
authors.lastname: Nakanishi
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: William
authors.initials: W
authors.lastname: Paz
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Pimentel
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Department of Medicine, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Imaging, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Ronak
authors.initials: R
authors.lastname: Rajani
mesh_terms: D000368:Aged; D000465:Algorithms; D002637:Chest Pain / Q000209:etiology; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D054644:Ear Auricle / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed