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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.
Insights
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.
Background:
Patients with hypertrophic cardiomyopathy (HCM) are not currently considered at elevated risk for infective endocarditis (IE) and are excluded from guideline-directed antibiotic prophylaxis, despite structural and haemodynamic features that may predispose to infection.
Methods:
This retrospective cohort study used real-world data from the TriNetX research network, a multicentre electronic health record platform. Adults aged ≥45 years with an ambulatory encounter between 1 January 2015 and 31 December 2019 and a diagnosis of HCM were identified and propensity score matched 1:1 to controls without HCM. A reference group of patients with prior valve intervention was also analysed. The primary outcome was 5-year cumulative incidence of IE, determined by International Classification of Diseases-10 codes. HRs and 95% CIs were calculated using Cox proportional hazards models.
Results:
Among 18 177 matched HCM-control pairs (mean (SD) age, 65.7 (10.4) years; 43.8% female), the 5-year cumulative incidence of IE was 3.25% in the HCM group and 1.31% in controls (HR, 2.62; 95% CI 2.20 to 3.12; p<0.001). In the valve intervention cohort (n=1916), IE incidence was 6.46% versus 1.52% in controls (HR, 4.21; 95% CI 2.62 to 6.75; p<0.001). In an exploratory subgroup of 231 HCM patients treated with mavacamten, no IE cases occurred during the 1-year follow-up period.
Conclusions:
Patients with HCM had more than twice the 5-year risk of IE compared with matched controls and approximately half the risk seen in patients with valve interventions. HCM may represent an intermediate-risk group not currently addressed in prophylaxis guidelines.
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