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Endocarditis infecciosa en la cardiomiopatía hipertrófica: prevalencia, incidencia y indicaciones para la profilaxis
P Spirito1, C Rapezzi, P Bellone
1Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy. p.spirito@galliera.it
Circulation
|April 27, 1999
Resumen
La endocarditis infecciosa en la cardiomiopatía hipertrófica (HCM) afecta principalmente a los pacientes con obstrucción del flujo de salida. La profilaxis con antibióticos se recomienda solo para pacientes con CMH obstructiva, especialmente aquellos con dilatación auricular.
Área de la Ciencia:
- Cardiología Cardiología.
- Enfermedades infecciosas Enfermedades infecciosas.
- Investigación médica Investigación médica.
Sus antecedentes:
- La endocarditis infecciosa (IE) en la cardiomiopatía hipertrófica (HCM) es poco conocida, con datos limitados principalmente de informes de casos.
- El riesgo preciso de IE en pacientes con HCM sigue sin definirse, lo que requiere una investigación adicional.
Objetivo del estudio:
- Evaluar la ocurrencia y los factores de riesgo de endocarditis infecciosa en una cohorte de pacientes con cardiomiopatía hipertrófica.
- Definir los subgrupos específicos de pacientes dentro de la CMH con mayor riesgo de endocarditis.
Principales métodos:
- Un análisis retrospectivo de 810 pacientes con cardiomiopatía hipertrófica evaluados entre 1970 y 1997.
- Se utilizó la ecocardiografía para identificar características de endocarditis previa y evaluar el tamaño auricular izquierdo y la obstrucción del flujo de salida.
- Se calcularon la prevalencia y las tasas de incidencia de la endocarditis, y se analizaron los factores de riesgo.
Principales resultados:
- La prevalencia de endocarditis previa fue de 3,7 por cada 1000 pacientes.
- La incidencia de endocarditis fue de 1,4 por cada 1000 personas-año, significativamente asociada con la obstrucción del flujo de salida (P = 0,006) y el tamaño del atrio izquierdo (P = 0,007).
- Los pacientes con obstrucción y dilatación auricular tuvieron una incidencia marcadamente mayor de endocarditis (9,2 por cada 1000 personas-años).
Conclusiones:
- La endocarditis infecciosa en HCM se observa predominantemente en pacientes con obstrucción del flujo de salida.
- La combinación de la obstrucción del flujo de salida y la dilatación auricular aumenta aún más el riesgo de endocarditis en pacientes con CMH.
- La profilaxis antibiótica para la endocarditis debe dirigirse específicamente a pacientes con cardiomiopatía hipertrófica obstructiva.
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