Earlobe Crusade as Useful Screening for Coronary Artery Disease in Low- and Middle-Income Countries of Asian; Bring the Ear-Heart Axis to the Spotlight in Cardiology: Systematic Review and Implications for Clinical Practice

Abstract

Background: Asia has the highest cardiovascular disease mortality worldwide, with most of these deaths occurring in low-income developing countries (lower- and middle-income countries [LMIC]). When compounded with issues in LMICs, such as minimal health resources and inadequate access to health facilities, these challenges make early detection efforts utilizing sophisticated diagnostic tools challenging. Earlobe crusade (ELC), an atherosclerosis marker, is the solution. Objective: This research assessed the relationship between ELC and coronary artery disease (CAD) evidenced by coronary angiography (CAD-CAG-confirmed) in LMIC Asian populations. Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis approach to identify studies on the connection between ELC and CAD-CAG-confirmed in LMIC Asian populations. LMIC classification in Asia based on World Bank statistical data through 2021. This study searched MEDLINE, Embase, ProQuest, and Scopus using population, intervention, comparison, and outcome criteria. Then, the risk of bias and diagnostic value was evaluated. Results: This systematic review found six articles with 1657 participants. All studies showed a significant relationship between the presence of ELC and CAD. ELC diagnostic values for CAD, sensitivity 74%–98%, and specificity 52.5%–91.49%. Several multivariate regression analysis studies showed that ELC was independently associated with CAD. Conclusion: The ELC examination is the best option for CAD screening in countries with limited resources and health facilities. ELC is straightforward, affordable, and valuable as a CAD diagnostic marker.