Infective endocarditis in hypertrophic cardiomyopathy: Prevalence, incidence, and indications for antibiotic prophylaxis

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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2132-2137
Number of pages6
Issue number16
Publication statusPublished - Apr 27 1999


  • Cardiomyopathy
  • Echocardiography
  • Hypertrophy

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine


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