[Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin]. / Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco.

BACKGROUND AND 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. PATIENTS AND METHOD: 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.

Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco / Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin

FUNDAMENTO Y OBJETIVO: El origen respiratorio o cardíaco de la disnea no siempre es fácil de establecercon las herramientas diagnósticas disponibles. Muchos pacientes presentan a la vez procesoscardiológicos y pulmonares que la justifica. El papel que puede desempeñar el recuentode hemosiderófagos (RH) en esputo en este contexto no ha sido establecido suficientemente.El objetivo fue determinar la utilidad en la predicción y el diagnóstico del RH en pacientes condisnea de origen cardíaco, y si varía tras el tratamiento.PACIENTES Y MÉTODO: Hemos realizado el RH a 61 pacientes que consultaron por disnea en urgenciasy cuyo origen fue determinado por la historia clínica de urgencias, el curso clínico y la realizaciónde pruebas funcionales respiratorias y ecocardiograma.RESULTADOS: El RH fue superior en los pacientes con disnea de origen cardíaco (n = 35), 37%(intervalo de confianza [IC] del 95%, 26-47) o de origen cardiopulmonar (n = 9), 30% (IC del95%, 8-52) que el de origen respiratorio (n = 17), 15% (IC del 95%, 4-27). La sensibilidad(52%), especificidad (88%), valores predictivos positivo (92%) y negativo (58%) se determinaronpara un punto de corte del RH del 30%. El modelo de predicción de disnea de origen cardíaco,incluido el RH, presentó un área bajo la curva ROC de 0,978 (IC del 95%, 0,95-1).CONCLUSIONES: El RH refleja la gravedad de la alteración de la permeabilidad venocapilar pulmonar,identifica a la mayoría de los pacientes que presentan o han presentado disfunción o insuficienciacardíaca moderada o grave y predice la disnea de origen cardíaco. Su utilidad debecentrarse en casos seleccionados

BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to findout using the available diagnostic tools. Many patients present both heart and lung diseasesthat cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in thiscontext has not been well settled so far. The objective was to describe the prediction usefulnessof HC in patients suffering from dyspnea of heart origin, and to find out if HC changed afteradministering treatment.PATIENTS AND METHOD: HC was analized in 61 patients whose main symptom was dyspnea in theemergency department, and it was evaluated by means of clinical history, clinical course andperformance of lung function tests and echocardiography.RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea oflung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea ofheart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI,, 8-52) than in patientswith dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administeringtreatment. The sensitivity (52%), specificity (88%), positive predictive value (92%)and negative predictive value (58%) was established for a 30% HC cutoff. The prediction modelof 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 cardiacdysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focuson selected patients