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Infective endocarditis in hypertrophic cardiomyopathy: a real-world matched cohort analysis
Akiva Rosenzveig1, Nicholas Platek1, Faysal Massad1
1Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Heart (British Cardiac Society)
|April 15, 2026
Summary
Patients with hypertrophic cardiomyopathy (HCM) have a significantly higher risk of infective endocarditis (IE). This study suggests HCM patients may need consideration for antibiotic prophylaxis guidelines.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Hypertrophic cardiomyopathy (HCM) patients are not currently recognized as high-risk for infective endocarditis (IE).
- Current guidelines do not recommend antibiotic prophylaxis for HCM patients despite potential predisposing factors.
Purpose of the Study:
- To evaluate the risk of IE in adult patients with HCM.
- To compare IE incidence in HCM patients versus matched controls and patients with prior valve interventions.
Main Methods:
- Retrospective cohort study using TriNetX electronic health records (EHR) data.
- Propensity score matching of 18,177 HCM patients (aged ≥45) with controls.
- Analysis of 5-year cumulative incidence of IE using Cox proportional hazards models.
Main Results:
- HCM patients had a 5-year IE incidence of 3.25% compared to 1.31% in controls (HR 2.62).
- Patients with prior valve intervention showed a higher IE incidence (6.46%) than controls (1.52%).
- No IE cases were observed in a small exploratory group of HCM patients treated with mavacamten during 1-year follow-up.
Conclusions:
- Patients with HCM face more than double the 5-year risk of IE compared to controls.
- HCM represents an intermediate-risk group potentially warranting inclusion in IE prophylaxis guidelines.
- Further research may clarify the role of specific treatments like mavacamten in IE prevention for HCM.
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