Frank sign ilk kez akut koroner sendromla başvuran hastalarda daha ileri koroner arter hastalığını öngörebilir

Yıl 2022, Cilt: 13 Sayı: 1, 103 - 109, 26.03.2022

Kadriye Gayretli Yayla Mustafa Bilal Özbay İdris Yakut Yasin Özen Mevlüt Serdar Kuyumcu Mustafa Karanfil Ahmet Ertem Çağrı Yayla

https://doi.org/10.18663/tjcl.1058293

Öz

Amaç: Frank Sign olarak da adlandırılan diyagonal kulak memesi kırışıklığı (DELC), kulak memesinin derisinde çapraz kıvrım veya kırışık benzeri bir çizgidir. Fizik muayenede tespit edilen bu işaret, yüksek kardiyovasküler hastalık riski taşıyan bireyler için prognostik bir belirteç olarak önerilmiştir. Çalışmamızın amacı, ilk kez akut koroner sendrom (AKS) tanısı almış hastalarda DELC varlığı ile koroner arter hastalığı şiddeti arasındaki ilişkiyi SYNTAX skoruna göre değerlendirmektir.
Gereç ve Yöntem: Kasım 2015-Aralık 2016 tarihleri arasında AKS tanısı ile acil servise başvuran 356 hasta çalışmaya alındı. Hastalar 3 gruba ayrıldı: düşük SYNTAX skoru (< 23), yüksek SYNTAX skoru (≥23) ve normal koroner hastaları.
Bulgular: DELC'li hastalar yüzde olarak tüm gruplar arasında istatistiksel olarak anlamlı derecede farklıydı (p < 0,001). Daha yüksek DELC sayısı (OR = 0.497; %95 CI: 0.246-1.001; p = 0.043), çoklu lineer regresyon analizinden sonra AKS hastalarında yüksek SYNTAX skoru için bağımsız bir öngörücüydü.
Sonuç: Frank Sign, birincil uygulayıcıların CAD'nin ciddiyetini tahmin etmelerine yardımcı olabilir.

Anahtar Kelimeler

Akut koroner sendrom, Diyagonal kulak memesi kırışıklığı, Frank Sign, SYNTAX skoru.

Frank sign may predict more advanced coronary artery disease in patients admitted with a first time acute coronary syndrome

Öz

Aim: Diagonal ear lobe crease (DELC), also called as Frank's sign, is a diagonal fold or wrinkle-like line in the skin of the earlobe. This sign detected on the physical examination was proposed as a surrogate marker for individuals at high risk of cardiovascular disease. The aim of our study was to assess the relationship between presence of DELC and the severity of coronary artery disease according to the SYNTAX score in patients with firstly diagnosed acute coronary syndrome (ACS).
Material and Methods: 356 patients admitted to the emergency department with the diagnosis of ACS from November 2015 to December 2016 were enrolled into the study. Patients were stratified into 3 groups: low SYNTAX score (< 23), high SYNTAX score (≥23) and patients with normal coronary.
Results: Patients with DELC as percentage were statistically significantly different between all groups (p < 0.001). Higher number of DELC (OR = 0.497; 95% CI: 0.246-1.001; p = 0.043) was an independent predictor for a high SYNTAX score in the ACS patients after multiple linear regression analysis.
Conclusion: Frank’s sign can help primary practitioners to predict severity of CAD.

Anahtar Kelimeler

Acute coronary syndrome, Diagonal ear lobe crease, Frank’s sign, SYNTAX score.

Kaynakça

• 1. Zapata-Wainberg G, Vivancos J. Images in clinical medicine: Bilateral earlobe creases. N Engl J Med 2013; 368: 32.
• 2. Frank ST. Aural sign of coronary-artery disease. N Engl J Med 1973; 289: 327-8.
• 3. Ishii T, Asuwa N, Masuda S, Ishikawa Y, Shimada K, Takemoto S. Earlobe crease and atherosclerosis. An autopsy study. J Am Geriatr Soc 1990; 38: 871-6.
• 4. Celik S, Erdogan T, Gedikli O, Kiris A, Erem C. Diagonal ear-lobe crease is associated with carotid intima-media thickness in subjects free of clinical cardiovascular disease. Atherosclerosis 2007; 192: 428-31.
• 5. Friedlander AH, Scully C. Diagonal ear lobe crease and atherosclerosis: a review of the medical literature and oral and maxillofacial implications. J Oral Maxillofac Surg 2010; 68: 3043-50.
• 6. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998; 9: 16-23.
• 7. Serruys PW, Onuma Y, Garg S et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention 2009; 5: 50-6.
• 8. Chevalier B, Silber S, Park SJ et al. Randomized comparison of the Nobori Biolimus A9-eluting coronary stent with the Taxus Liberte paclitaxel-eluting coronary stent in patients with stenosis in native coronary arteries: the NOBORI 1 trial--Phase 2. Circ Cardiovasc Interv 2009; 2: 188-95.
• 9. Wang Y, Mao LH, Jia EZ et al. Relationship between diagonal earlobe creases and coronary artery disease as determined via angiography. BMJ Open 2016; 6: 8558.
• 10. Lichtstein E, Chapman I, Gupta PK et al. Letter: Diagonal ear-lobe crease and coronary artery sclerosis. Ann Intern Med 1976; 85: 337-8.
• 11. Shoenfeld Y, Mor R, Weinberger A, Avidor I, Pinkhas J. Diagonal ear lobe crease and coronary risk factors. J Am Geriatr Soc 1980; 28: 184-7.
• 12. Sapira JD. Earlobe creases and macrophage receptors. South Med J 1991; 84: 537-8.
• 13. Elliott WJ. Ear lobe crease and coronary artery disease. 1,000 patients and review of the literature. Am J Med 1983; 75: 1024-32.
• 14. Toyosaki N, Tsuchiya M, Hashimoto T et al. Earlobe crease and coronary heart disease in Japanese. Heart Vessels 1986; 2: 161-5.
• 15. Shmilovich H, Cheng VY, 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: 1283-7.
• 16. Kaukola S. The diagonal ear-lobe crease, a physical sign associated with coronary heart disease. Acta Med Scand Suppl 1978; 619: 1-49.
• 17. Bouissou H, Pieraggi MT, Julian M et al. Value of skin biopsy in coronary insufficiency. Arch Mal Coeur Vaiss 1973; 66: 655-60.
• 18. Higuchi Y, Maeda T, Guan JZ, Oyama J, Sugano M, Makino N. Diagonal earlobe crease are associated with shorter telomere in male Japanese patients with metabolic syndrome. Circ J 2009; 73: 274-9.
• 19. Serruys PW, Morice MC, Kappetein AP et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360: 961-72.
• 20. Farooq V, Serruys PW, Bourantas C et al. Incidence and multivariable correlates of long-term mortality in patients treated with surgical or percutaneous revascularization in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial. Eur Heart J 2012; 33: 3105-13.
• 21. Garg S, Serruys PW, Silber S et al. The prognostic utility of the SYNTAX score on 1-year outcomes after revascularization with zotarolimus- and everolimus-eluting stents: a substudy of the RESOLUTE All Comers Trial. JACC Cardiovasc Interv 2011; 4: 432-41.
• 22. Çelik M, Sokmen E, Erer M et al. Akut st-elevasyonlu miyokart infarktüsü hastalarinda 6 aylik mortalite ve thiol / disulfid ilişkisi. Turk J Clin Lab 2020; 11: 47-54.
• 23. Sokmen E, Celik M. Monosit/Yüksek-yoğunluklu lipoprotein kolesterol oranının, perkütan koroner girişim uygulanan akut st-elevasyonlu miyokard enfarktüsü hastalarında 3- aylık mortaliteyi öngördürmede nötrofil/lenfosit oranına üstünlüğü. Turk J Clin Lab 2019; 10: 459-66.