Introduction : Heart failure (HF) is a common, costly, and often fatal condition and highly prevalent among elder people of the general population. HF is a progressive disease and severe HF may ask for advanced treatments such as heart transplantation (HTx) or mechanical circulatory support (MCS) in selected patients. The number of the patients with advanced HF increases in Switzerland, and due to the limited availability of donor hearts, MCS is applied in an increasing number of advanced HF patients either while waiting for HTx or as destination therapy.
Iron deficiency (ID) is a common comorbidity in HF, in particular in patients with advanced HF. In addition, iron metabolism is known for its interaction with the immune system. This interaction may be of importance since MCS treatment is associated with an important risk of driveline infection.
Objectives : This study examines in patients on MCS treatment listed for heart transplantation the association between driveline infection and parameters of iron metabolism.
Methodology : This retrospective observational study identified 75 patients heart transplantation candidates waiting for transplant opertaion while on continuous-flow MCS treatment. Patients were implanted between May 2008 to December 2022. Patients' data derived from electronic files and document demographic as well as pre- and post-implantation clinical and biological characteristics.
Results: 42/75 were included into this observational study; Patients were excluded because of premature death (n=3), long hospitalization post-implantation (n=8), and incomplete documentation (n=22). The baseline characteristics showed no significant differences between patients remaining in the final analysis and patients that were excluded except for ischemic cardiomyopathy and dyslipidemia which more prevalent in the study participants. A total of 718 swabs searching for driveline infection were documented; 365/718 swabs showed bacterial driveline infection. Patients with driveline infection had higher serum iron and hemoglobin levels while ferritin levels were lower. Univariable logistic analysis showed that the higher hemoglobin and transferrin levels were positively associated with incident driveline infection (OR 1.044, 95% CI 1.005-1.024, p=0.002; OR 1.03, 95%CI 1.006-1.055, p=0.014; respective) while ferritin levels were negatively related (OR =.99, 95%CI 0.000- 0.999, p=0.014).
Conclusion : The study result suggest association of parameters of iron metabolism with the incidence of driveline infection warranting further investigation.