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Intravascular imaging assessment of pharmacotherapies targeting atherosclerosis: advantages and limitations in predicting their prognostic implications.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Serruys, Patrick Washington 
Bennett, Martin Richard  ORCID logo  https://orcid.org/0000-0002-2565-1825

Abstract

Intravascular imaging has been often used over the recent years to examine the efficacy of emerging therapies targeting plaque evolution. Serial intravascular ultrasound, optical coherence tomography, or near-infrared spectroscopy-intravascular ultrasound studies have allowed us to evaluate the effects of different therapies on plaque burden and morphology, providing unique mechanistic insights about the mode of action of these treatments. Plaque burden reduction, a decrease in necrotic core component or macrophage accumulation-which has been associated with inflammation-and an increase in fibrous cap thickness over fibroatheromas have been used as surrogate endpoints to assess the value of several drugs in inhibiting plaque evolution and improving clinical outcomes. However, some reports have demonstrated weak associations between the effects of novel treatments on coronary atheroma and composition and their prognostic implications. This review examines the value of invasive imaging in assessing pharmacotherapies targeting atherosclerosis. It summarizes the findings of serial intravascular imaging studies assessing the effects of different drugs on atheroma burden and morphology and compares them with the results of large-scale trials evaluating their impact on clinical outcome. Furthermore, it highlights the limited efficacy of established intravascular imaging surrogate endpoints in predicting the prognostic value of these pharmacotherapies and introduces alternative imaging endpoints based on multimodality/hybrid intravascular imaging that may enable more accurate assessment of the athero-protective and prognostic effects of emerging therapies.

Description

Keywords

Coronary atherosclerosis, Intravascular ultrasound, Lipid-lowering drugs, Near-infrared spectroscopy, Optical coherence tomography, Humans, Plaque, Atherosclerotic, Prognosis, Atherosclerosis, Coronary Artery Disease, Biomarkers, Coronary Vessels

Journal Title

Cardiovasc Res

Conference Name

Journal ISSN

0008-6363
1755-3245

Volume Title

119

Publisher

Oxford University Press (OUP)
Sponsorship
British Heart Foundation (FS/19/66/34658)
British Heart Foundation (CH/2000003/12800)
British Heart Foundation (PG/18/14/33562)
British Heart Foundation (RE/18/1/34212)
British Heart Foundation (TA/F/20/210001)