Methods Study Population Genotyped individuals with hypertrophic cardiomyopathy and their relatives, identified through clinical tests or clinical evaluation, were recruited and assigned to 1 of three groups. Mutation carriers with a left ventricular wall structure thickness of 12 mm or better or a z rating of 2 or more 35 were categorized as having overt hypertrophic cardiomyopathy. Healthy mutation carriers who did not meet these criteria were categorized as mutation carriers without left ventricular hypertrophy. The criteria we used are more rigorous than those used to diagnose hypertrophic cardiomyopathy clinically.36 These were chosen to avoid the inclusion of topics with borderline still left ventricular hypertrophy and potentially emerging or mild cardiomyopathy in the group of mutation carriers without left ventricular hypertrophy.All vaccinated topics were contained in the analyses. Immunogenicity data on SBA titers were designed for at least 93 percent of the topics at each time stage in both studies. Demographic and clinical features of the subjects are summarized in the Supplementary Appendix. Immunogenicity Immunogenicity was measured 4 weeks after principal vaccination. In study A, 96.0 percent of the subjects in the PsA-TT group had SBA titers which were in least four times as high as those at baseline, in comparison with 63.7 percent of subjects in the PsACWY group and 35.6 percent of those in the Hib-TT group .