title: Infective endocarditis in hypertrophic cardiomyopathy: A multicenter, prospective, cohort study.
abstract: Infective endocarditis (IE) complicating hypertrophic cardiomyopathy (HCM) is a poorly known entity. Although current guidelines do not recommend IE antibiotic prophylaxis (IEAP) in HCM, controversy remains.This study sought to describe the clinical course of a large series of IE HCM and to compare IE in HCM patients with IE patients with and without an indication for IEAP.Data from the GAMES IE registry involving 27 Spanish hospitals were analyzed. From January 2008 to December 2013, 2000 consecutive IE patients were prospectively included in the registry. Eleven IE HCM additional cases from before 2008 were also studied. Clinical, microbiological, and echocardiographic characteristics were analyzed in IE HCM patients (n = 34) and in IE HCM reported in literature (n = 84). Patients with nondevice IE (n = 1807) were classified into 3 groups: group 1, HCM with native-valve IE (n = 26); group 2, patients with IEAP indication (n = 696); group 3, patients with no IEAP indication (n = 1085). IE episode and 1-year follow-up data were gathered.One-year mortality in IE HCM was 42% in our study and 22% in the literature. IE was more frequent, although not exclusive, in obstructive HCM (59% and 74%, respectively). Group 1 exhibited more IE predisposing factors than groups 2 and 3 (62% vs 40% vs 50%, P < 0.01), and more previous dental procedures (23% vs 6% vs 8%, P < 0.01). Furthermore, Group 1 experienced a higher incidence of Streptococcus infections than Group 2 (39% vs 22%, P < 0.01) and similar to Group 3 (39% vs 30%, P = 0.34). Overall mortality was similar among groups (42% vs 36% vs 35%, P = 0.64).IE occurs in HCM patients with and without obstruction. Mortality of IE HCM is high but similar to patients with and without IEAP indication. Predisposing factors, previous dental procedures, and streptococcal infection are higher in IE HCM, suggesting that HCM patients could benefit from IEAP.
authors.affiliation: aDepartment of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro bInfectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro cClinical Microbiology and Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón dHealth Research Institute Gregorio Marañón, CIBER Respiratory Diseases-CIBERES (CB06/06/0058), Medical School, Complutense University, Madrid eInfectious Diseases Unit, Hospital Universitario Marqués de Valdecilla fDepartment of Cardiology, Hospital Universitario Marqués de Valdecilla gDepartment of Cardiology, Hospital de Sierrallana, Santander hInfectious Diseases Unit, Hospital Clinic-IDIBAPS, Barcelona University iDepartment of Cardiology, Hospital Clinic-IDIBAPS, Barcelona University, Barcelona jDepartment of Infectious Diseases, Hospital Universitario Virgen del Rocío, Seville kInfectious Diseases Unit, Complejo Hospitalario Universitario A Coruña, A Coruña lDepartment of Cardiology, Hospital Virgen de la Victoria, Málaga mInfectious Diseases Unit, Hospital Universitario Cruces, País Vasco University, Bilbao nDepartment of Internal Medicine, Hospital Costa del Sol, Marbella, Málaga oDepartment of Internal Medicine-Infectious Diseases, Hospital Universitario Virgen de la Arrixaca, Medical School, Murcia University, Murcia pMyocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Dominguez
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Maricela C
authors.initials: MC
authors.lastname: Valerio
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Fariñas
authors.forename: José Ramón
authors.initials: JR
authors.lastname: de Berrazueta
authors.forename: Jesús
authors.initials: J
authors.lastname: Zarauza
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Pericás Pulido
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Paré
authors.forename: Arístides
authors.initials: A
authors.lastname: de Alarcón
authors.forename: Dolores
authors.initials: D
authors.lastname: Sousa
authors.forename: Isabel
authors.initials: I
authors.lastname: Rodriguez Bailón
authors.forename: Miguel
authors.initials: M
authors.lastname: Montejo-Baranda
authors.forename: Mariam
authors.initials: M
authors.lastname: Noureddine
authors.forename: Elisa
authors.initials: E
authors.lastname: García Vázquez
authors.forename: Pablo
authors.initials: P
authors.lastname: Garcia-Pavia
mesh_terms: D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies