Advertisement

Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign

Published:February 12, 2020DOI:https://doi.org/10.1016/j.hrtlng.2020.01.008

      Highlights

      • Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary Disease: 'Frank's sign.
      • Cardiovascular diseases are the most common and important comorbidity causes in patients with Chronic Obstructive Pulmonary Disease.
      • Diagonal earlobe crease (Frank's sign) was associated with coronary artery and peripheral vascular diseases.
      • An earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity.

      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.

      Keywords

      Abbreviations:

      COPD (chronic obstructive pulmonary disease), Delc (diagonal earlobe crease), Pft (pulmonary function tests), Cvd (cardiovascular diseases), Cad (coronary artery disease), Gold (global initiative for chronic obstructive lung disease), Fev1 (forced expiratory volume at 1st second), FVC (Forced Vital Capacity), SaO2 (Arterial oxygen saturation), CRP (C-Reactive Protein), HDL (High Density Lipoprotein), LDL (Low Density Lipoprotein), hs-CRP (high-sensitivity C-reactive protein), PTX3 (Pentraxin3), MDA-LDL (Malondialdehyde Low Density Lipoprotein)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lozano R.
        • Naghavi M.
        • Foreman K.
        • et al.
        Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010.
        Lancet. 2012; 380: 2095-2128https://doi.org/10.1016/S0140-6736(12)61728-0
        • Mannino D.M.
        • Brown C.
        • Giovino G.A.
        Obstructive lung disease in the United States from 1979 to 1993: An analysis using multiple-cause mortality data.
        Am J Respir Crit Care Med. 1997; 156: 814-818https://doi.org/10.1164/ajrccm.156.3.9702026
        • Gupta N.K.
        • Agrawal R.K.
        • Srivastav A.B.
        • Ved M.L.
        Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease.
        Lung India. 2011; 28: 105-109https://doi.org/10.4103/0970-2113.80321
        • Ghoorah K.
        • De Soyza A.
        • Kunadian V.
        Increased cardiovascular risk in patients with chronic obstructive pulmonary disease and the potential mechanisms linking the two conditions: A review.
        Cardiol Rev. 2013; 21: 196-202https://doi.org/10.1097/CRD.0b013e318279e907
        • Bhatt S.P.
        • Dransfield M.T.
        Chronic obstructive pulmonary disease and cardiovascular disease.
        Transl Res. 2013; 162: 237-251https://doi.org/10.1016/j.trsl.2013.05.001
        • Frank S.T.
        Aural sign of coronary-artery disease.
        N Engl J Med. 1973; 289: 327-328https://doi.org/10.1056/nejm197308092890622
        • Korkmaz L.
        • Agac M.T.
        • Acar Z.
        • et al.
        Earlobe crease may provide predictive information on asymptomatic peripheral arterial disease in patients clinically free of atherosclerotic vascular disease.
        Angiology. 2014; 65: 303-307https://doi.org/10.1177/0003319713479651
        • Montazeri M.
        • Rashidi N.
        • Montazeri M.
        • et al.
        Is diagonal earlobe crease a marker for coronary artery disease?.
        Heart India. 2014; 4: 104-106https://doi.org/10.4103/2321-449X.146614
        • Kamal R.
        • Kausar K.
        • Qavi A.H.
        • et al.
        Diagonal earlobe crease as a significant marker for coronary artery disease: a case-control study.
        Cureus. 2017; 9: e1013https://doi.org/10.7759/cureus.1013
        • Wu X.
        • Yang D.
        • Zhao Y.
        • et al.
        Diagonal earlobe crease and coronary artery disease in a Chinese population.
        BMC Cardiovasc Disord. 2014; 14: 2-8https://doi.org/10.1186/1471-2261-14-43
        • Kang E.H.
        • Kang H.C.
        Association between earlobe crease and the metabolic syndrome in a cross-sectional study.
        Epidemiol Health. 2012; 34e2012004https://doi.org/10.4178/epih/e2012004
        • Koyama T.
        • Watanabe H.
        • Ito H.
        The association of circulating inflammatory and oxidative stress biomarker levels with diagonal earlobe crease in patients with atherosclerotic diseases.
        J Cardiol. 2016; 67: 347-351https://doi.org/10.1016/j.jjcc.2015.06.002
        • Kaukola S.
        The diagonal ear-lobe crease, a physical sign associated with coronary heart disease.
        Acta Med Scand. 1978; 619 (PMID:279228): 1-49
        • Friedlander A.H.
        • López J.L.
        • Ortega E.V.
        Diagonal ear lobe crease and atherosclerosis: a review of the medical literature and dental implications.
        Med Oral Patol Oral Cir Bucal. 2012; 17: e153-e159https://doi.org/10.4317/medoral.17390
        • Shmilovich H.
        • Cheng V.Y.
        • Rajani R.
        • et al.
        Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography.
        Am J Cardiol. 2012; 109: 1283-1287https://doi.org/10.1016/j.amjcard.2011.12.024
        • Davis T.M.
        • Balme M.
        • Jackson D.
        • et al.
        The diagonal ear lobe crease (Frank’s sign) is not associated with coronary artery disease or retinopathy in type 2 diabetes: the Fremantle Diabetes Study.
        Aust N Z J Med. 2000; 30 (PMID:11108067): 573-577
        • Elliott W.J.
        • Karrison T.
        Increased all-cause and cardiac morbidity and mortality associated with the diagonal earlobe crease: A prospective cohort study.
        Am J Med. 1991; 9: 247-254https://doi.org/10.1016/0002-9343(91)90123-f
        • Higashi Y.
        • Noma K.
        • Yoshizumi M.
        • et al.
        Oxidative stress and endothelial function in cardiovascular diseases (review).
        Circ J. 2009; 73: 411e418https://doi.org/10.1253/circj.cj-08-1102
        • Oda N.
        • Maruhashi T.
        • Kishimoto S.
        • et al.
        Relation of the bilateral earlobe crease to endothelial dysfunction.
        Am J Cardiol. 2017; 119: 1983-1988https://doi.org/10.1016/j.amjcard.2017.03.029
        • Sethi S.
        • Wrona C.
        • Eschberger K.
        • et al.
        Inflammatory profile of new bacterial strain exacerbations of chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2008; 177: 491-497https://doi.org/10.1164/rccm.200708-1234OC
        • Vernooy J.H.
        • Kucukaycan M.
        • Jacobs J.A.
        • et al.
        Local and systemic inflammation in patients with chronic obstructive pulmonary disease: soluble tumor necrosis factor receptors are increased in sputum.
        Am J Respir Crit Care Med. 2002; 166: 1218-1224https://doi.org/10.1164/rccm.2202023
        • Rahman I.
        • Morrison D.
        • Donaldson K.
        • et al.
        Systemic oxidative stress in asthma, COPD, and smokers.
        Am J Respir Crit Care Med. 1996; 154: 1055-1060https://doi.org/10.1164/ajrccm.154.4.8887607
        • Williams R.R.
        Myocardial infarction risk, earlobe crease, and sleep apnoea syndrome.
        Lancet. 1989; 2: 676-677https://doi.org/10.1016/s0140-6736(89)90917-3
        • Evrengul H.
        • Dursunoglu D.
        • Kaftan A.
        • et al.
        Bilateral diagonal earlobe crease and coronary artery disease: a significant association.
        Dermatology. 2004; 209: 271-275https://doi.org/10.1159/000080847
        • Christoffersen M.
        • Frikke-Schmidt R.
        • Schnohr P.
        • et al.
        Visible age-related signs and risk of ischemic heart disease in the general population.
        Circulation. 2014; 129: 990-998https://doi.org/10.1161/CIRCULATIONAHA.113.001696
        • Wang Y.
        • Mao L.H.
        • Jia E.Z.
        • et al.
        Relationship between diagonal earlobe creases and coronary artery disease as determined via angiography.
        BMJ Open. 2016; 6e008558
        • Del Brutto O.H.
        • Mera R.M.
        • Costa A.F.
        • et al.
        The association between earlobe crease (Frank’s sign) and abnormal ankle-brachial index determination is related to age: a population-based study.
        Int J Vasc Med. 2018; 4735731https://doi.org/10.1155/2018/4735731
        • Ambrose J.A.
        • Barua R.S.
        The pathophysiology of cigarette smoking and cardiovascular disease: an update.
        J Am Coll Cardiol. 2004; 43: 1731-1737https://doi.org/10.1016/j.jacc.2003.12.047