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Case Reports
. 2025 Mar 5;30(5):103087.
doi: 10.1016/j.jaccas.2024.103087.

Endocarditis and Hypertrophic Cardiomyopathy

Sebastiano Bertola  1 , Davide Margonato  2 , Alessandra Roccabruna  1 , Martina Belli  2 , Alessandro Malagoli  3 , Martina Setti  1 , Federica Ilardi  4 , Matteo Lisi  5 , Giulia Elena Mandoli  6 , Maria Concetta Pastore  6 , Simona Sperlongano  7 , Marco Matteo Ciccone  8 , Saverio Muscoli  9 , Eustachio Agricola  2 , Giovanni Benfari  10 , Matteo Cameli  6 , Antonello D'Andrea  11 ; Working Group of Echocardiography of the Italian Society of Cardiology
Affiliations
Case Reports

Endocarditis and Hypertrophic Cardiomyopathy

Sebastiano Bertola et al. JACC Case Rep. .

Abstract

Infective endocarditis (IE) is an uncommon but potentially fatal complication in patients affected by hypertrophic cardiomyopathy (HCM). The risk has been described to be significantly higher than in the general population, but the incidence of IE in HCM population remains unknown. The complex pathophysiology of this disease, characterized by structural alterations of the mitral valve apparatus and the presence of turbulent flow that promotes the deposition of microorganisms, could provide a substrate for IE and may, to some extent, explain its higher incidence in this specific population. The purpose of this case series is to highlight the correlation between endocarditis and HCM, a concern that has also been raised in recent European guidelines.

Keywords: HOCM; LVOTO; endocarditis; mitral valve.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Transthoracic Case of Endocarditis in Obstructive Hypertrophic Cardiomyopathy (A) Transthoracic apical 4-chamber view showing severe interventricular septal hypertrophy (20.8 mm) (left) and a vegetation attached to the anterior mitral leaflet (right). (B) Systolic aliasing confirming the diagnosis of hypertrophic cardiomyopathy with systolic anterior motion–related outflow tract obstruction (resting peak gradient 135 mm Hg).
Figure 2
Figure 2
Transesophageal Case of Endocarditis in Obstructive Hypertrophic Cardiomyopathy Midesophageal long-axis view showing a vegetation measuring 15.3 × 6.9 mm attached to the anterior mitral valve leaflet (left), resulting in moderate regurgitation with combined systolic aliasing by left ventricular outflow tract obstruction (right).
Figure 3
Figure 3
Mixed Mitral Regurgitation and Stenosis and Severe LVOTO in the Presence of Endocarditis (A) Transthoracic baseline evaluation, apical 4-chamber view (interventricular septal thickness 19 mm) with systolic anterior motion (left), and 3-chamber view showing moderate to severe mitral regurgitation (right). (B) Continuous-wave Doppler spectral curves showing mitral regurgitation and dagger-shaped intraventricular acceleration with a peak gradient of 156 mm Hg (left) and moderate to severe mitral stenosis (mean gradient 10 mm Hg) resulting from the vegetation (right).
See this image and copyright information in PMC

References

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