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Infective endocarditis in hypertrophic cardiomyopathy A multicenter, prospective, cohort study

By Fernando Dominguez, Antonio Ramos, Emilio Bouza, Patricia Muñoz, Maricela C. Valerio, Carmen Fariñas, José Ramón De Berrazueta, Jesús Zarauza, Juan Manuel Pericás Pulido, Juan Carlos Paré, Arístides De Alarcón, Dolores Sousa, Isabel Rodriguez Bailón, José Miguel Montejo Baranda, Mariam Noureddine, Elisa García Vázquez and Pablo Garcia-Pavia

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.This work was supported in part by grant RD12/0042/0066 by the Plan Estatal de I+D+I 2013-2016 funded by the ISCIII European Regional Development Fund (FEDER) "A way of making Europe"

Topics: antibiotic prophylaxis, endocarditis, hypertrophic cardiomyopathy, bacterial-endocarditis, prophylaxis, prevention, diagnaosis, recommendations, guidelines
Publisher: 'Ovid Technologies (Wolters Kluwer Health)'
Year: 2016
DOI identifier: 10.1097/MD.0000000000004008
OAI identifier: oai:addi.ehu.es:10810/25056
Provided by: Communities in ADDI
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