[Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin].
OBJECTIVE
The respiratory or heart origin of dyspnea is not always easy to find out using the available diagnostic tools. Many patients present both heart and lung diseases that cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in this context has not been well settled so far. The objective was to describe the prediction usefulness of HC in patients suffering from dyspnea of heart origin, and to find out if HC changed after administering treatment.


METHODS
HC was analyzed in 61 patients whose main symptom was dyspnea in the emergency department, and it was evaluated by means of clinical history, clinical course and performance of lung function tests and echocardiography.


RESULTS
35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea of lung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea of heart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI, 8-52) than in patients with dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administering treatment. The sensitivity (52%), specificity (88%), positive predictive value (92%) and negative predictive value (58%) was established for a 30% HC cutoff. The prediction model of heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1).


CONCLUSIONS
HC reflects the severity of pulmonary venocapillar disturbance, identifies the majority of patients suffering from current or past heart failure or severe cardiac dysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focus on selected patients.
Bellido-Casado
Jesús
J
Departamento de Neumología, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Belda
José
J
Bayés-Genís
Antonio
A
Margarit
Gisela
G
López
Laura
L
Casan
Pere
P
Hernán Cotes
Carlos
C
Antón
Antonio
A
Santaló
Miguel
M
Ordóñez-Llanos
Jordi
J
D000328:Adult; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006485:Hemosiderin / Q000032:analysis*; D006801:Humans; D008264:Macrophages / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013183:Sputum / Q000737:chemistry*; D018754:Ventricular Dysfunction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology
D006485:Hemosiderin