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(Circulation. 1999;99:2132-2137.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Infective Endocarditis in Hypertrophic Cardiomyopathy

Prevalence, Incidence, and Indications for Antibiotic Prophylaxis

Paolo Spirito, MD; Claudio Rapezzi, MD; Pietro Bellone, MD; Sandro Betocchi, MD; Camillo Autore, MD; Maria Rosa Conte, MD; Gian Paolo Bezante, MD; Paolo Bruzzi, MD, PhD

From the Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, (P.S.); Istituto di Malattie dell'Apparato Cardiovascolare, Università di Bologna, Policlinico Sant'Orsola, Bologna (C.R.); Divisione di Cardiologia, Ospedale Santa Corona, Pietra Ligure (P. Bellone); II Faculta di Medicina e Chirurgia, Università di Napoli (S.B); Dipartimento di Scienze Cardiovascolari e Respiratorie, Università La Sapienza, Rome (C.A.); Divisione di Cardiologia, Ospedale degli Infermi, Rivoli, Torino (M.R.C.); Cattedra di Cardiologia, Dipartimento di Medicina Interna, Università degli Studi, Genoa (G.P.B.); and Servizio di Epidemiologia Clinica, Istituto Nazionale per la Ricerca sul Cancro, Genoa (P. Bruzzi).

Correspondence to Paolo Spirito, MD, Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Via Volta 8, 16128 Genoa, Italy. E-mail p.spirito{at}galliera.it

Background—The literature on infective endocarditis in hypertrophic cardiomyopathy (HCM) is virtually confined to case reports. Consequently, the risk of endocarditis in HCM remains undefined.

Methods and Results—We assessed the occurrence of endocarditis in 810 HCM patients evaluated between 1970 and 1997. Endocarditis was diagnosed in 10 patients, 2 of whom were excluded from analysis of prevalence and incidence because they were referred for acute endocarditis. At first evaluation, echocardiographic features consistent with prior endocarditis were identified in 3 of 808 patients, a prevalence of 3.7 per 1000 patients (95% CI, 0.8 to 11). Of 681 patients who were followed, 5 developed endocarditis, an incidence of 1.4 per 1000 person-years (95% CI, 0.5 to 3.2); outflow obstruction was present in each of these 5 patients and was associated with the risk of endocarditis (P=0.006). In the 224 obstructive patients, incidence of endocarditis was 3.8 per 1000 person-years (95% CI, 1.6 to 8.9) and probability of endocarditis 4.3% at 10 years. Left atrial size was also associated with the risk of endocarditis (P=0.007). In patients with both obstruction and atrial dilatation (50 mm), incidence of endocarditis increased to 9.2 per 1000 person-years (95% CI, 2.5 to 23.5). Analysis of all 10 patients with endocarditis identified outflow obstruction in each and atrial dilatation in 7.

Conclusions—Endocarditis in HCM is virtually confined to patients with outflow obstruction and is more common in those with both obstruction and atrial dilatation. These results indicate that antibiotic prophylaxis is required only in patients with obstructive HCM.

Key Words: hypertrophy • cardiomyopathy • echocardiography

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