Sims Jason R, Anavekar Nandan S, Bhatia Subir, O'Horo John C, Geske Jeffrey B, Chandrasekaran Krishnaswamy, Wilson Walter R, Baddour Larry M, Gersh Bernard J, DeSimone Daniel C
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2018 Feb 15;121(4):480-484. doi: 10.1016/j.amjcard.2017.11.010. Epub 2017 Nov 23.
Infective endocarditis (IE) is an infection of the inner lining of the heart with high morbidity and mortality despite medical and surgical advancements in recent decades. Hypertrophic cardiomyopathy (HC) is one of several medical conditions that have been linked to an increased risk of IE, but there is a paucity of data on this association. We therefore sought to define the clinical phenotype of IE in patients with HC at a single tertiary care center. A retrospective cohort of 30 adult patients with HC diagnosed with IE between January 1, 2006 and December 31, 2016 at Mayo Clinic Rochester were identified. Similar rates of aortic (n = 14) and mitral (n = 16) valve involvement by IE were noted (47% vs 53%). This finding persisted even in patients with left-ventricular outflow tract obstruction and systolic anterior motion of the mitral valve. Symptomatic embolic complications occurred in 10 cases (33%). Surgical intervention was performed in 11 cases (37%). One-year mortality was remarkably low at 7%. In conclusion, in the largest single-center cohort of IE complicating HC, there were similar rates of both mitral and aortic valve involvement regardless of the presence of left ventricular outflow tract obstruction, which is contrary to a long-standing tenet regarding the association of HC and IE. Moreover, no "high risk" IE subset was identified based on HC-related parameters.
感染性心内膜炎（IE）是一种心脏内膜感染，尽管近几十年来医学和外科手术取得了进展，但它的发病率和死亡率仍然很高。肥厚型心肌病（HC）是与IE风险增加相关的几种疾病之一，但关于这种关联的数据很少。因此，我们试图在一家三级医疗中心确定HC患者中IE的临床表型。我们确定了一个回顾性队列，其中包括2006年1月1日至2016年12月31日期间在罗切斯特梅奥诊所被诊断为患有IE的30名成年HC患者。观察到IE累及主动脉瓣（n = 14）和二尖瓣（n = 16）的比例相似（47%对53%）。即使在有左心室流出道梗阻和二尖瓣收缩期前向运动的患者中，这一发现仍然存在。10例（33%）出现有症状的栓塞并发症。11例（37%）接受了手术干预。1年死亡率低至7%。总之，在最大的单中心HC合并IE队列中，无论是否存在左心室流出道梗阻，二尖瓣和主动脉瓣受累的比例相似，这与关于HC和IE关联的长期观点相反。此外，基于与HC相关的参数，未识别出“高危”IE亚组。
