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Retoric study: initial results

Session Poster session 5

Speaker Julia Karady

Event : EuroEcho 2017

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Non-coronary Cardiac Intervention
  • Session type : Poster Session

Authors : J Karady (Budapest,HU), A Apor (Budapest,HU), M Kolossvary (Budapest,HU), B Szilveszter (Budapest,HU), A Panajotu (Budapest,HU), FI Suhai (Budapest,HU), AL Jermendy (Budapest,HU), P Orosz (Budapest,HU), D Milanovich (Budapest,HU), AI Nagy (Budapest,HU), AA Molnar (Budapest,HU), L Molnar (Budapest,HU), R Rajani (London,GB), B Merkely (Budapest,HU), P Maurovich-Horvat (Budapest,HU)

Authors:
J Karady1 , A Apor1 , M Kolossvary1 , B Szilveszter1 , A Panajotu1 , FI Suhai1 , AL Jermendy1 , P Orosz2 , D Milanovich2 , AI Nagy1 , AA Molnar1 , L Molnar1 , R Rajani3 , B Merkely1 , P Maurovich-Horvat1 , 1Semmelweis University Heart Center, MTA-SE Lendulet Cardiovascular Imaging Research Group - Budapest - Hungary , 2Semmelweis University, Department of Neurology - Budapest - Hungary , 3St Thomas' Hospital, Cardiology Department - London - United Kingdom ,

On behalf: Cardiovascular Imaging Research Group

Citation:
European Heart Journal Supplements ( 2017 ) 18 ( Supplement 3 ), iii334

Background: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical valve replacement in high-risk patients with aortic stenosis. The appearance of subclinical hypo-attenuated leaflet thickening (HALT) of the prosthetic valve on contrast-enhanced computed tomography (CT) images is a recently described phenomenon. The RETORIC (Rule Out Transcatheter Aortic Valve Thrombosis with Post Implantation Computed Tomography) study aims to define the incidence, predictors and clinical relevance of HALT following TAVI.

Methods: The predominant inclusion criterion is patients who have previously undergone or are scheduled to undergo a TAVI. The predominant inclusion criterion is patients who have previously undergone or are scheduled to undergo a TAVI procedure with self-expandable valve system. The study is comprised of two cohorts. Cohort A includes those patients who have previously undergone a TAVI and Cohort B includes those patients who are scheduled to undergo a TAVI.  All patients undergo comprehensive cardiac CT, transthoracic echocardiography (TTE), brain magnetic resonance imaging (MRI) and comprehensive neurological evaluation. In Cohort A, all HALT positive patients receive oral anticoagulant therapy (OAC), while in Cohort B patients are randomized to standard therapy and OAC therapy or standard therapy alone. After 4 months, HALT positive patients from both Cohort A and B undergo repeat cardiac CT, TTE and brain MRI to determine the effects of anticoagulation based on the presence and volume of HALT.

Results: As of May 2017, the RETORIC study has enrolled 116 patients to Cohort A arm (78.2 ± 11.5 years, 55% females) and 53 to Cohort B arm (79,8 ± 6,3 years, 50% females). The average time between TAVI and CT was 16.2 ± 10.4 months in Cohort A.  The current prevalence of HALT in Cohort A is 4.3%, whereas in Cohort B further follow-up data is awaited.

Conclusion: The RECTORIC study may provide valuable information on the relevance of subclinical HALT appearance and OAC therapy in TAVI patients.

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