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Echocardiographic measurement of epicardial adipose tissue thickness. Arrow indicates epicardial adipose tissue.
Source publication
Objective:
Atherosclerotic coronary artery disease is a leading cause of death, worldwide. Diagonal earlobe crease (DELC) has been suggested as a simple, noninvasive marker of cardiovascular disease. Although epicardial adipose tissue (EAT) thickness and carotid intima media thickness (CIMT) are closely related to atherosclerosis, the relation bet...
Context in source publication
Context 1
... was iden- tified as echocardiographic free space between the outer wall of the myocardium and the visceral layer of the pericardium. EAT thickness was perpendicu- larly measured on the free wall of the right ventricle at end diastole in 3 cardiac cycles ( Figure 2). Parasternal long-and short-axis views provided the most accurate measurement of EAT in the right ventricle, with opti- mal cursor beam orientation in each view. ...
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Citations
... Despite these results, some populations exhibit contradictory results: a study carried out in Turkey indicates that in the presence of DELC, patients with asymptomatic hypertension but no coronary disease present a higher frequency of diabetes mellitus (P � 0.02), smoking (P � 0.002), and a higher BMI (P � 0.004) as well as a signifcant diference in the values of the cardio-ankle vascular index [30]. Nevertheless, another investigation in the same population shows that patients without coronary artery disease have no signifcant diferences between subjects with and without DELC with respect to arterial hypertension, diabetes mellitus, smoking, BMI, lowdensity lipoprotein cholesterol (LDL-C), cholesterol bound to high-density lipoproteins (HDL-C), and TG [33]. In this sense, even though subjects with DELC and without cardiovascular disease have higher epicardial adipose tissue (EAT) and carotid intimal media thickness (CIMT) than subjects without DELC [29,33] and both EAT and CIMT are associated with coronary disease [34,35], it was not found that EAT and CIMT present a signifcant correlation with BMI, HDL-C, LDL-C, and TG [33]. ...
... Nevertheless, another investigation in the same population shows that patients without coronary artery disease have no signifcant diferences between subjects with and without DELC with respect to arterial hypertension, diabetes mellitus, smoking, BMI, lowdensity lipoprotein cholesterol (LDL-C), cholesterol bound to high-density lipoproteins (HDL-C), and TG [33]. In this sense, even though subjects with DELC and without cardiovascular disease have higher epicardial adipose tissue (EAT) and carotid intimal media thickness (CIMT) than subjects without DELC [29,33] and both EAT and CIMT are associated with coronary disease [34,35], it was not found that EAT and CIMT present a signifcant correlation with BMI, HDL-C, LDL-C, and TG [33]. Finally, an investigation carried out in the USA found no relationship between DELC and CVRF: arterial hypertension, diabetes mellitus, smoking, weight, and hypercholesterolemia [36]. ...
... Nevertheless, another investigation in the same population shows that patients without coronary artery disease have no signifcant diferences between subjects with and without DELC with respect to arterial hypertension, diabetes mellitus, smoking, BMI, lowdensity lipoprotein cholesterol (LDL-C), cholesterol bound to high-density lipoproteins (HDL-C), and TG [33]. In this sense, even though subjects with DELC and without cardiovascular disease have higher epicardial adipose tissue (EAT) and carotid intimal media thickness (CIMT) than subjects without DELC [29,33] and both EAT and CIMT are associated with coronary disease [34,35], it was not found that EAT and CIMT present a signifcant correlation with BMI, HDL-C, LDL-C, and TG [33]. Finally, an investigation carried out in the USA found no relationship between DELC and CVRF: arterial hypertension, diabetes mellitus, smoking, weight, and hypercholesterolemia [36]. ...
Introduction. Cardiovascular risk factors such as obesity, type 2 diabetes, hypertension, smoking, and dyslipidemia enfold heart disease morbimortality. Diagonal earlobe crease has been proposed as a prognostic marker of extension and severity of illness in patients with acute coronary syndrome. But its usefulness remains unclear in patients with or without coronary disease. Methods. A case-control study was carried out on a total of 805 patients with and without cardiovascular risk factors or acute coronary syndrome. Univariate and multivariate binary logistic regression analyses were used to determine the probability of having diagonal earlobe crease with the presence of cardiovascular risk factors and acute coronary syndrome. Data were summarized as odds ratio with 95% confidence intervals and P values. Results. An unadjusted (univariate) analysis showed that being male, being older than 55 years, obesity, type 2 diabetes mellitus, arterial hypertension, smoking, and dyslipidemia, as well as having acute coronary syndrome, were associated with the presence of diagonal earlobe crease. The multivariate analysis showed that men (OR 1.6, 95% IC 1.1–2.4, P=0.007), being over 55 years old (OR 4.8, 95% IC 3.2–7.2, P<0.001), being obese (OR 2.1, 95% IC 1.4–3.1, P<0.001), having arterial hypertension (1.5, 95% IC 1.1–2.3, P=0.025), or suffering from acute coronary syndrome (OR 5.3, 95% IC 2.5–11.1, P<0.001), were independent factors associated with diagonal earlobe crease. The rest of cardiovascular risk factors were not relevant in the multivariate model. Conclusions. In Mexican adults, having an acute coronary syndrome is not the only factor associated with diagonal earlobe crease but also being a man, older than 55 years, having high blood pressure and obesity. Diagonal earlobe crease may simply be caused by changes in the skin and connective tissues of the ears because of the aging process, obesity, and/or being male. These factors, by themselves, enfold cardiovascular risk due to well-known pathophysiological causes.
... [1][2][3] This simple clinical sign that can be easily observed and was fi rst described by Frank in routine clinical examination in 1973 ,who reported the signifi cant association of ELC with increased risk for coronary artery disease. [1][2][3][4][5] From that year forward, several studies have evaluated the potential link between ELC and coronary risk factors or coronary artery disease. 1,3,5 However, there is still uncertainty regarding the relevance of ELC to coronary atherosclerosis burden despite the notable number of studies available on this issue. ...
... In the last decade, fat in pericardial cavity, owing to its anatomical proximity to heart and coronary vessels, was reported to be related to coronary atherosclerosis severity and prognosis via local release of infl ammatory mediators on adjacent coronary arteries leading to local infl ammation and pathophysiological changes, which may have a fundamental role in the development and progression of coronary atherosclerosis. 4,[6][7][8] Nevertheless, data on the association between ELC and pericardial fat volume (PFV), as a marker of clinical and subclinical coronary atherosclerosis, are limited in the literature. ...
... ELC presence showed a signifi cant independent association with increased CAC (OR [CI] = 3 [2][3][4][5][6][7][8][9][10], p <0.01), signifi -respectively. The categorical data, including coronary plaque and stenosis severity, were compared using chi-square test. ...
... al conducted a cross-sectional study with 130 patients. 30 cIMT was measured in CCA, at 1 cm of bifurcation. The authors determined that IMT was higher in the ELC group (0.85±0.16 vs. 0.60±0.15; ...
Traditionally a crease in the ear has been considered a visible marker of atherosclerosis. There is strong evidence of its association with coronary heart disease (CHD) revealed in several retrospective and prospective studies. However, the usefulness of the earlobe crease (ELC) as a marker of atherosclerotic diseases of other vascular beds, especially in the intracranial or extracranial carotid vasculature, is not clear. A non-systematic search of studies evaluating the association between ELC and atherosclerosis was performed. Observational studies that explored the association of ELC with atherosclerosis in many vascular beds were reviewed. Most studies presented methodological limitations, selection bias, and relatively small sample sizes. Discrepancies were found between studies, mainly due to the interaction of age in the association pathway. In a population cohort study, age was the main modifier of the effect of ELC with atherosclerosis in different vascular beds. The role of ELC as a marker of atherosclerosis remains unclear, at least for extra-coronary atherosclerosis.
... Ziyrek et al. [21] showed an association between the presence of diagonal earlobe crease and increased carotid intima-media thickness and epicardial adipose tissue thickness that the latter indicator can own strongly predict the severity of coronary artery disease. It also seems that the role of earlobe crease in the prediction of CAD can be augmented by the presence of other CAD risk factors such as hypertension and diabetes [21]. ...
... Ziyrek et al. [21] showed an association between the presence of diagonal earlobe crease and increased carotid intima-media thickness and epicardial adipose tissue thickness that the latter indicator can own strongly predict the severity of coronary artery disease. It also seems that the role of earlobe crease in the prediction of CAD can be augmented by the presence of other CAD risk factors such as hypertension and diabetes [21]. As shown by Kamal in 2017 [13], the effect of hypertension and diabetes on the presence of diagonal earlobe crease is statistically significant. ...
Background: The use of phenotypic parameters along with other noninvasive diagnostic modality can lead to early diagnosis of coronary artery disease (CAD) and prevent its life-threatening outcome. Recently, the application of head and face components for assessing the risk for CAD much attention has been paid. The present study aimed to assess the relationship between ear characteristics (transverse groove on the earlobe and hair growth on the ear) and the risk for CAD and its severity among Iranian patients. Materials and Methods: In this cross-sectional study, the study population consisted of 105 consecutive patients with suspected CAD undergoing coronary angiography. The severity of CAD was determined by the number of disease vessels as well as the presence of left main lesions assessed by coronary angiography. All patients were examined to evaluate the appearance of ear regarding the presence of transverse groove on the earlobe and hair growth on the ear. Results: Comparing cardiovascular parameters across the groups with and without transverse groove on the earlobe showed a higher rate of CAD as well as the higher number of involved coronary arteries than in the groups without transverse groove on the earlobe. Similarly, the presence of CAD and its higher severity were more revealed in patients with hair growth on the ear as compared to the group without this phenotype. According to multivariable logistic regression analysis and with the presence of baseline parameters, the presence of transverse groove on the earlobe and hair growth on the ear increased the risk for CAD by 2.4 and 4.4 fold, respectively. Conclusion: Along with classic cardiovascular risk factors, the role of growing hair on the ear and transverse groove on the ear to predict high risk for CAD should be considered. [GMJ.2020;8:e1443]
... Ziyrek et al. [21] showed an association between the presence of diagonal earlobe crease and increased carotid intima-media thickness and epicardial adipose tissue thickness that the latter indicator can own strongly predict the severity of coronary artery disease. It also seems that the role of earlobe crease in the prediction of CAD can be augmented by the presence of other CAD risk factors such as hypertension and diabetes [21]. ...
... Ziyrek et al. [21] showed an association between the presence of diagonal earlobe crease and increased carotid intima-media thickness and epicardial adipose tissue thickness that the latter indicator can own strongly predict the severity of coronary artery disease. It also seems that the role of earlobe crease in the prediction of CAD can be augmented by the presence of other CAD risk factors such as hypertension and diabetes [21]. As shown by Kamal in 2017 [13], the effect of hypertension and diabetes on the presence of diagonal earlobe crease is statistically significant. ...
Background:
The use of phenotypic parameters along with other noninvasive diagnostic modality can lead to early diagnosis of coronary artery disease (CAD) and prevent its life-threatening outcome. Recently, the application of head and face components for assessing the risk for CAD much attention has been paid. The present study aimed to assess the relationship between ear characteristics (transverse groove on the earlobe and hair growth on the ear) and the risk for CAD and its severity among Iranian patients.
Materials and methods:
In this cross-sectional study, the study population consisted of 105 consecutive patients with suspected CAD undergoing coronary angiography. The severity of CAD was determined by the number of disease vessels as well as the presence of left main lesions assessed by coronary angiography. All patients were examined to evaluate the appearance of ear regarding the presence of transverse groove on the earlobe and hair growth on the ear.
Results:
Comparing cardiovascular parameters across the groups with and without transverse groove on the earlobe showed a higher rate of CAD as well as the higher number of involved coronary arteries than in the groups without transverse groove on the earlobe. Similarly, the presence of CAD and its higher severity were more revealed in patients with hair growth on the ear as compared to the group without this phenotype. According to multivariable logistic regression analysis and with the presence of baseline parameters, the presence of transverse groove on the earlobe and hair growth on the ear increased the risk for CAD by 2.4 and 4.4 fold, respectively.
Conclusion:
Along with classic cardiovascular risk factors, the role of growing hair on the ear and transverse groove on the ear to predict high risk for CAD should be considered.
... It is also possible that the ELC might be genetically determined, which might explain its different correlates with atherosclerosis according to race/ethnicity [4]. Information on the association between ELC and the carotid intima-media thickness (cIMT) e a surrogate of extracranial atherosclerosis e is limited [5,6,7,8,9]. ...
... The same has occurred with studies attempting to assess the association between the ELC and other markers of atherosclerosis, including peripheral artery disease [15,16]. Most of the studies trying to demonstrate an association between ELC and cIMT disclosed an apparent association between both variables [5,6,7,8,9]. However, the aforementioned studies were flawed by either biased selection of participants, a small sample size, limited assessment of the cIMT to a single artery wall, and different cutoffs used for defining an increased cIMT ( Table 2). ...
The earlobe crease (ELC) has been linked to coronary artery disease, but there is
limited information on the association between ELC and extracranial
atherosclerosis. Using the Atahualpa Project cohort, we aimed to assess the
association between ELC and increased carotid intima-media thickness (cIMT).
Atahualpa residents aged �40 years underwent visual inspection of both earlobes
to evaluate ELC presence, and ultrasound examinations of carotid arteries to
calculate the cIMT. The association between both variables was assessed by
logistic regression and predictive models, after adjusting for relevant
confounders. Mean age of 570 enrolled individuals was 61.5 12.4 years (58%
women). ELC was present in 221 (39%) participants. The mean cIMT was 0.85
0.19 mm, with 81 individuals (14%) having an increased cIMT (>1 mm).
Univariate logistic regression showed a significant association between ELC
presence and increased cIMT (OR: 1.67; 95% C.I.: 1.04e2.69), which
disappeared when age (OR: 1.09; 95% C.I.: 0.65e1.85) and other covariables
(OR: 1.06; 95% C.I.: 0.62e1.84) were added to the model. Predictive cIMT margins did not differ according to ELC presence or absence, with participants
stratified in quartiles of age. This study shows that the effect of the increase in
cIMT in subjects with ELC is related to aging.
Introdução/ enquadramento/ objetivo
Num mundo ocidental marcado por uma elevada prevalência de alterações relacionadas com síndrome metabólica (obesidade, doenças cardiovasculares, diabetes mellitus tipo 2, hipertensão arterial, dislipidemias), torna-se essencial saber onde procurar sinais de forma precoce. Nas empresas, é comum encontrar trabalhadores com os múltiplos fatores de risco que a caracterizam, sendo que o ambiente e a organização do trabalho podem participar na patogénese (como escolhas alimentares desadequadas nas cantinas, bares ou máquinas de vending, organização do trabalho e stress, ou trabalho por turnos e seu impacto no ritmo circadiano). As suas consequências levarão a mais Certificados de Incapacidade Temporária por doença, mais acidentes de trabalho e mais perda de produtividade para as Empresas. Por isso, nos serviços de Saúde Ocupacional, poderá existir outro caminho que investa na promoção da saúde e do bem-estar, além da prevenção direta de doenças profissionais e acidentes de trabalho, analisando o trabalhador num ponto de vista global, em toda a sua definição de Saúde, e atuando em sinergia com os Cuidados de Saúde Primários. O principal objetivo deste trabalho consiste na elaboração de uma revisão de manifestações cutâneas que possam fornecer pistas no exame físico, tendo como maior foco a síndrome metabólica.
Metodologia
Trata-se de uma Scoping Review, iniciada através de uma pesquisa realizada nas bases de dados EBSCO (CINAHL, MEDLINE, Nursing & Allied Health Collection: Comprehensive, Cochrane Database, MedicLatina), PUBMED e RCAAP, durante os meses de Junho e Julho de 2020. As palavras-chave utilizadas foram: “Manifestações cutâneas”, “Sinais na pele”, “Resistência à insulina”, “Síndrome metabólica”, bem como as suas traduções em inglês (Skin manifestations, Insulin resistance, Skin signs, Metabolic syndrome).
Resultados
Foram encontrados vários sinais sugestivos de Síndrome Metabólica ou resistência à insulina, nomeadamente acanthosis nigricans, acrocórdons, xantelasmas, xantomas eruptivos, prega lobular auricular diagonal, alopécia androgenética, algumas manifestações de carácter inflamatório (acne, hidradenite supurativa) e autoimune (psoríase, vitiligo).
Conclusões
É fundamental o incentivo a mudanças de estilo de vida que atenuem/ eliminem a Síndrome Metabólica. Capacitar ou relembrar os profissionais das técnicas de avaliação não invasivas de reconhecimento de sinais, pode contribuir para auxiliar a equipa a detetar manifestações metabólicas, simplesmente olhando para a pele de quem cuidam. Esta abordagem pode ser uma mais-valia nos serviços de Saúde Ocupacional, que se encontram na vanguarda do acompanhamento de adultos, e cujo curso da doença poderá ser controlado ou mesmo revertido, com diagnóstico e intervenção precoce. De facto, analisar o trabalhador em toda a sua definição de saúde (agregando a Medicina/ Enfermagem Preventiva à Curativa) e atuando em sinergia com os Cuidados de Saúde Primários, acabará por influenciar positivamente a produtividade das empresas (ao prevenir baixas médicas por doença, ou até mesmo em reduzir acidentes de trabalho).
