Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography

Haim Shmilovich, Victor Y. Cheng, Ronak Rajani, Damini Dey, Balaji K. Tamarappoo, Ryo Nakazato, Thomas W R Smith, Yuka Otaki, Rine Nakanishi, Heidi Gransar, William Paz, Raymond T. Pimentel, Sean W. Hayes, John D. Friedman, Louise E J Thomson, Daniel S. Berman

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)1283-1287
Number of pages5
JournalAmerican Journal of Cardiology
Volume109
Issue number9
DOIs
StatePublished - May 1 2012

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Ear
Coronary Artery Disease
Computed Tomography Angiography
Chi-Square Distribution
Coronary Vessels
Pathologic Constriction
Logistic Models
Odds Ratio
Demography
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography. / Shmilovich, Haim; Cheng, Victor Y.; Rajani, Ronak; Dey, Damini; Tamarappoo, Balaji K.; Nakazato, Ryo; Smith, Thomas W R; Otaki, Yuka; Nakanishi, Rine; Gransar, Heidi; Paz, William; Pimentel, Raymond T.; Hayes, Sean W.; Friedman, John D.; Thomson, Louise E J; Berman, Daniel S.

In: American Journal of Cardiology, Vol. 109, No. 9, 01.05.2012, p. 1283-1287.

Research output: Contribution to journalArticle

Shmilovich, H, Cheng, VY, Rajani, R, Dey, D, Tamarappoo, BK, Nakazato, R, Smith, TWR, Otaki, Y, Nakanishi, R, Gransar, H, Paz, W, Pimentel, RT, Hayes, SW, Friedman, JD, Thomson, LEJ & Berman, DS 2012, 'Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography', American Journal of Cardiology, vol. 109, no. 9, pp. 1283-1287. https://doi.org/10.1016/j.amjcard.2011.12.024
Shmilovich, Haim ; Cheng, Victor Y. ; Rajani, Ronak ; Dey, Damini ; Tamarappoo, Balaji K. ; Nakazato, Ryo ; Smith, Thomas W R ; Otaki, Yuka ; Nakanishi, Rine ; Gransar, Heidi ; Paz, William ; Pimentel, Raymond T. ; Hayes, Sean W. ; Friedman, John D. ; Thomson, Louise E J ; Berman, Daniel S. / Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography. In: American Journal of Cardiology. 2012 ; Vol. 109, No. 9. pp. 1283-1287.
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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.",
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T1 - 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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AU - Cheng, Victor Y.

AU - Rajani, Ronak

AU - Dey, Damini

AU - Tamarappoo, Balaji K.

AU - Nakazato, Ryo

AU - Smith, Thomas W R

AU - Otaki, Yuka

AU - Nakanishi, Rine

AU - Gransar, Heidi

AU - Paz, William

AU - Pimentel, Raymond T.

AU - Hayes, Sean W.

AU - Friedman, John D.

AU - Thomson, Louise E J

AU - Berman, Daniel S.

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N2 - 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.

AB - 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.

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