Abstract
Atherosclerosis is a systemic disease that affects most vascular beds. The gold standard of atherosclerosis imaging has been invasive intravascular ultrasound (IVUS). Newer noninvasive imaging modalities like B-mode ultrasound, cardiac computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have been used to assess these vascular territories with high accuracy and reproducibility. These imaging modalities have lately been used for the assessment of the atherosclerotic plaque and the response of its volume to several medical therapies used in the treatment of patients with cardiovascular disease. To study the impact of these medications on atheroma volume progression or regression, imaging modalities have been used on a serial basis providing a unique opportunity to monitor the effect these antiatherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging, quantitative coronary angiography (QCA), B-mode ultrasound, electron beam computed tomography (EBCT), and dynamic contrast-enhanced magnetic resonance imaging have all been used to evaluate the impact of therapeutic strategies that modify cholesterol and blood pressure on the progression/regression of atherosclerotic plaque. In this review, we intend to summarize the impact of different therapies aimed at halting the progression or even result in regression of atherosclerotic cardiovascular disease evaluated by different imaging modalities.
Highlights
Atherosclerosis is a systemic disease that can affect multiple vascular beds and is associated with significant mortality and morbidity
The primary interest of cardiovascular researchers in surrogate end points as a proxy for clinical outcomes stems from the fact that the evaluation of the effect of treatment on surrogate outcomes is often quicker and requires a smaller number of patients to demonstrate. The use of these surrogate endpoints has been recently criticized because at the time of food and drug administration (FDA) approval, information remains incomplete about idiosyncratic reactions, off-target effects or delayed adverse effects
The clearly recognized inherent limitations of noninvasive imaging modalities as well as quantitative coronary angiography in providing an accurate estimate of plaque burden can clearly distort the correlation of surrogate endpoints and clinical outcomes
Summary
Atherosclerosis is a systemic disease that can affect multiple vascular beds and is associated with significant mortality and morbidity. The enthusiasm for measuring plaque volume is because increments in the size of atherosclerotic plaque correlate with major adverse cardiovascular events (MACE) [3, 4] Such observations have fueled efforts at studying medications that target plaque regression or decrease progression early on in patients with atherosclerotic coronary artery disease (CAD). This is based on the premise that a favorable effect of novel therapies on atherosclerotic plaque volume would translate into a favorable clinical effect, and help efficiently triage novel therapies from the laboratory bench to the bedside. We provide a review of medications that target plaque volume
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