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

Published:February 12, 2020DOI:


      • 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.



      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.


      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.


      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.



      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)
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