ReviewJournal of clinical medicine2021
Diagonal Earlobe Crease (Frank's Sign) for Diagnosis of Coronary Artery Disease: A Systematic Review of Diagnostic Test Accuracy Studies.
Review in Journal of clinical medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 30 citations in OpenAlex.
- Association of Diagonal Earlobe Crease (Frank's Sign) with Intracranial Aneurysm Rupture at Small Sizes.Brain sciences · 2026Article
- Frank's Sign and Risk of Cardiovascular Events in Patients Hospitalized for Pneumonia: A Prospective Single-Center Cohort Study.Journal of clinical medicine · 2026Article
- Diagnostic model for angiographic obstructive coronary artery disease combining CHG, DELC, and traditional risk factors: a bootstrap validation study.Frontiers in endocrinology · 2026Article
- Article
- Article
- Cardiodermatology: the heart of the connection between the skin and cardiovascular disease.Nature reviews. Cardiology · 2025Review
- Prevalence of Frank's sign in healthy young individuals, morphological characteristics, and its association with family history of chronic disease.Forensic science, medicine, and pathology · 2024Article
- Association of Diagonal Earlobe Crease with Risk of Atrial Fibrillation in Stable Patients with Coronary Artery Disease.Journal of clinical medicine · 2024Article
- Artificial intelligence-enhanced patient evaluation: bridging art and science.European heart journal · 2024Review
- Association of advanced glycation end products with ear lobe crease: A cross-sectional study.Journal of diabetes · 2024Article
- Clinical Value of the Diagonal Earlobe Crease in Patients with Chest Pain for Diagnosing Coronary Heart Disease.International journal of general medicine · 2024Article
- Cutaneous signs of selected cardiovascular disorders: A narrative review.Open medicine (Warsaw, Poland) · 2024Review
- Warning Function of Frank's Sign in Pre-Existing Cardiac Disease Patients: A Case Report.Case reports in cardiology · 2024Article
- The relationship of diagonal earlobe crease (Frank's sign) and obstructive coronary artery disease in patients undergoing coronary angiography.Wiener klinische Wochenschrift · 2023Article
- The Relationship between the Presence of an Earlobe Crease and Overactive Bladder: A Cross-Sectional Case-Controlled Study.Medicina (Kaunas, Lithuania) · 2023Article
- The importance of inspection in clinical cardiology: Frank's sign.Clinical case reports · 2022Article
- Frank's sign and paired ear creases of the helix : Current concepts of significance for morbidity.Wiener klinische Wochenschrift · 2022Review
- What do Steven Spielberg, Mel Gibson and Emperor Hadrian have in common? Frank's sign and the link with coronary artery disease.Oxford medical case reports · 2021Article
- Patients with Earlobe Crease May Associate with Lower Concentration of the Age-Suppressing Hormone Klotho.International journal of general medicine · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Coronary artery disease is a global challenge for healthcare systems. Early diagnosis is a key issue to improve quality of life and reduce morbidity and mortality. Diagonal earlobe crease, a wrinkle extending obliquely across the earlobe, was linked by many authors to various atherosclerotic diseases. This systematic review aimed at summarizing the diagnostic accuracy of diagonal earlobe crease for diagnosis of chronic and acute coronary syndromes in adults. Cochrane's recommendations for systematic reviews of diagnostic test accuracy studies were followed. The protocol was registered on PROSPERO. Seven electronic databases were searched up to April 2021. The risk of bias and applicability were assessed using the QUADAS-2 tool. Meta-analysis was not performed. Finally, 13 cross-sectional studies evaluating 3951 patients were analyzed, all of which focused on chronic coronary syndromes defined as anatomically significant coronary stenosis. Invasive coronary angiography was used as a reference in most studies, except one which utilized computed tomography angiography. Sensitivity ranged from 26% to 90%, and specificity from 32% to 96%. Positive likelihood ratios varied from 1.11 to 7.03, but most results were below 2. Negative likelihood ratios were from 0.84 to 0.30, but most values exceeded 0.5. Diagnostic accuracy of diagonal earlobe crease for the detection of chronic coronary syndromes is insufficient. It only slightly changes pre-test probability, and its mere presence or absence should not affect the clinical management of the patients. However, for its feasibility and easy interpretation, Frank's sign could be considered as a part of physical examination.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.