Frank's sign and coronary artery disease: Myth or fact?

Introduction: Frank's sign is a diagonal earlobe crease proposed as a potential clinical marker of coronary artery disease. However, its diagnostic value remains debated. Objective: To determine the prevalence of Frank's sign in patients with confirmed coronary artery disease and assess its association with disease severity. Methodology: This cross-sectional study included 213 patients with confirmed coronary artery disease. We divided patients into three groups based on the presence of Frank's sign: no Frank's sign (n=77), unilateral Frank's sign (n=87), and bilateral Frank's sign (n=49). We analysed demographic characteristics, cardiovascular risk factors, coronary angiographic findings, treatment modality, and left ventricular ejection fraction. Results: Frank's sign was present in 136 patients (63.85%). Of these, 87 (63.97%) had a unilateral sign and 49 (36.03%) a bilateral sign. Patients without Frank's sign were significantly younger (p < 0.001), while arterial hypertension was significantly more common among patients with bilateral Frank's sign (100%; p = 0.037). Single-vessel coronary artery disease was more common in patients with unilateral Frank's sign. In contrast, multivessel disease was more common in patients without Frank's sign and those with bilateral Frank's sign (p < 0.001). Patients with bilateral Frank's sign were more likely to require surgical myocardial revascularisation than those in the other groups (61.22%; p = 0.035). Conclusion: Frank's sign was common among patients with coronary artery disease. Bilateral Frank's sign was associated with multivessel coronary artery disease, and these patients more frequently underwent surgical myocardial revascularisation. These findings suggest that Frank's sign may serve as a simple clinical marker of advanced coronary artery disease. However, further research is needed to define its prognostic value better.