Diagonal earlobe crease as a predictor of high-risk coronary plaques and long-term cardiovascular outcomes: The DEAR study

Abstract Background The diagonal earlobe crease (DELC) has been proposed as a clinical marker of atherosclerosis, but its association with coronary artery disease (CAD) remains controversial. Coronary computed tomography angiography (CCTA) provides non-invasive assessment of coronary high-risk plaque (HRP) features, which is predictive of future adverse cardiovascular events. However, the relationship between HRP and DELC has not been fully elucidated. Furthermore, the prognostic value of DELC and HRP in long-term cardiovascular outcomes remains unclear. Purpose This study aimed to investigate the association between DELC and coronary atherosclerosis, as assessed by HRP on CCTA. It also examined the prognostic impact of DELC and HRP on all-cause mortality and repeated revascularization. Methods This prospective cohort study included 955 patients with chronic coronary syndrome (CCS) who underwent CCTA after exclusions. All patients were examined for the presence of the DELC. Following CCTA, two blinded radiologists assessed the presence of HRP. Patients were followed for 40.7 ± 12.3 months, with all-cause mortality and the need for repeated revascularization defined as the primary endpoint. The association between DELC and HRP was analyzed, and Kaplan-Meier survival analysis was performed to assess long-term outcomes based on both DELC status and HRP presence. Results The presence of DELC was significantly associated with HRP (p < 0.001), suggesting a potential link between this marker and coronary atherosclerosis. In multivariate logistic regression analysis, several factors were found to be independent predictors of HRP. Age was inversely associated with HRP (OR: 0.936, 95% CI: 0.921–0.952, p < 0.001), while male gender showed a strong positive association (OR: 3.304, 95% CI: 2.349–4.648, p < 0.001). Additionally, DELC remained an independent predictor of HRP (OR: 1.446, 95% CI: 1.053–1.985, p = 0.023). During the follow-up period of 40.7 ± 12.3 months, Kaplan-Meier survival analysis demonstrated significantly worse long-term outcomes in patients with DELC compared to those without (p = 0.008). Similarly, patients with HRP on CCTA exhibited markedly higher rates of adverse cardiovascular events, including all-cause mortality and the need for repeated revascularization (p < 0.001). Conclusion DELC was significantly associated with HRP on CCTA, indicating its potential as a clinical marker of coronary atherosclerosis. Both DELC and HRP independently predicted worse long-term outcomes, including higher all-cause mortality and repeated revascularization. These findings suggest that DELC may aid in cardiovascular risk stratification in patients with CCS.Figure 1  Figure 2