title: [Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin].
abstract: 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.
authors.affiliation: Departamento de Neumología, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Bellido-Casado
authors.forename: José
authors.initials: J
authors.lastname: Belda
authors.forename: Antonio
authors.initials: A
authors.lastname: Bayés-Genís
authors.forename: Gisela
authors.initials: G
authors.lastname: Margarit
authors.forename: Laura
authors.initials: L
authors.lastname: López
authors.forename: Pere
authors.initials: P
authors.lastname: Casan
authors.forename: Carlos
authors.initials: C
authors.lastname: Hernán Cotes
authors.forename: Antonio
authors.initials: A
authors.lastname: Antón
authors.forename: Miguel
authors.initials: M
authors.lastname: Santaló
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordóñez-Llanos
mesh_terms: 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
chemical_list: D006485:Hemosiderin