Frank's sign: silent predictor of coronary artery disease

A 60 year old non hypertensive, non diabetic male presented in casualty with complaints of exertional breathlessness of 2 days duration. ECG and cardiac enzymes were within normal limit. General physical examination was normal except for the finding of bilateral ear lobe creases (Figure 1 & 2). With the possibility of angina equivalent patient was posted for coronary angiography which revealed total occlusion of left anterior descending artery and right coronary artery, 80% obtuse marginal and 70% left circumflex artery. LVEF was 25% and patient was advised for high risk CABG. Creased earlobes (Frank's sign) were alleged to be associated with an increased risk of coronary artery disease.