Cardiovascular
Medicine
Franck’s sign
Coronary artery disease Franck’s sign ear lobe crease
A sign of coronary artery disease?

Franck’s sign

Images in Cardiovascular Medicine
Coronary artery disease Franck’s sign ear lobe crease
Florian REY
Additional authors
Ulysse Voirol, Georgios GIANNAKOPOULOS
Issue
2017/06
DOI:
https://doi.org/10.4414/cvm.2017.00485
Cardiovascular Medicine. 2017;20(06):162-163
Affiliations
Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland

Published on 21.06.2017

Case description

A 61-year-old obese female with Parkinson’s disease ­reported recurrent chest pain and exertional dyspnoea in the previous 24 hours. Clinical examination was normal, but careful inspection of both ear lobes showed bilateral oblique creases extending backwards from the intertragic notch to the edge of the lobule (fig. 1, panels A–B). The electrocardiogram was unremarkable; however, cardiac troponin was mildly ­elevated. A coronary angiogram showed two-vessel coronary ­artery disease, which was successfully treated with drug-eluting stents (fig. 1, panel C–D). The subsequent course was uneventful and the patient was discharged on dual antiplatelet therapy and a statin and counselled for intensive cardiovascular risk factor management including cardiac rehabilitation.
Figure 1: Panel A–B: Right and left ears with Franck’s sign or ear lobe crease. Panel C: Proximal right ­coronary ­artery subocclusion. Panel D: Mid left anterior descending artery subocclusion. The patient gave her consent for the publication of the images.
Ear lobe crease, commonly referred as “Franck’s sign”, was initially described more than forty years ago by Sanders T. Franck, as a cutaneous sign of coronary ­artery disease. Several pathophysiological explanations have been proposed, including loss of elastic fibres due to increased free radical oxidative stress and diminished blood supply in the absence of collateral vessels in the ear lobe. A substantial number of studies have evaluated the diagnostic performance of ear lobe crease as a marker of coronary artery disease. In a ­recent meta-analysis including more than 31 000 ­patients, Franck’s sign was associated with a 3.3-fold ­increase in the risk of coronary artery disease. The sign itself had sensitivity of 62% and specificity of 67%.
The finding of Franck’s sign should thus prompt further questioning for conventional cardiovascular risk factors and family history of coronary artery disease.
No financial support and no other potential conflict of interest ­relevant to this article was reported.
Correspondence:
Ulysse Voirol
University of Geneva,
Medical Faculty
Rue Michel-Servet 1
CH-1206 Genève
ulysse.voirol[at]etu.unige.ch

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