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.
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