This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.08.067v1 49/9/925    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Böse, D. Articles by Erbel, R. Search for Related Content PubMed PubMed Citation Articles by Böse, D. Articles by Erbel, R. Related Collections Related Article

STATE-OF-THE-ART PAPER AND COMMENTARY: STATE-OF-THE-ART PAPER AND COMMENTARY

Intravascular Ultrasound for the Evaluation of Therapies Targeting Coronary Atherosclerosis

Dirk Böse, MD^_*, Clemens von Birgelen, MD, PhD and Raimund Erbel, MD^_*,_*

^_* Department of Cardiology, University of Duisburg-Essen, Essen, Germany
Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands

Manuscript received February 28, 2006; revised manuscript received August 21, 2006, accepted August 26, 2006.

^_* Reprint requests and correspondence: Dr. Raimund Erbel, University-Professor of Cardiology, Department of Cardiology, West German Heart Center, University Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany. (Email: erbel{at}uk-essen.de).

Many cardiovascular events are clinical manifestations of underlying atherosclerotic disease. The progression of atherosclerosis, traditionally measured by angiography, is predictive of future clinical events and is a valid surrogate marker of cardiovascular (CV) disease. There is growing interest in using novel surrogate end points in clinical trials to expedite the development of new CV therapies. Innovative imaging technologies, such as intravascular ultrasound (IVUS), may carry advantages for the evaluation of coronary atherosclerotic burden and disease progression. Unlike angiography, which displays only the opacified luminal "silhouette," IVUS provides transmural imaging of the entire arterial wall and permits both detection of early-stage atherosclerosis and accurate cross-sectional and even 3-dimensional quantification of plaques. Intravascular ultrasound is now used to guide therapeutic interventions and for diagnostic purposes, primarily for the evaluation of ambiguous lesions and left main coronary artery disease. In addition, clinical studies are using IVUS serially to measure plaque progression, which appears to be related to future CV events. Although the probative force of clinical end point studies still is stronger, IVUS is catching up. Currently, several trials of CV therapies use IVUS-determined plaque progression as the end point. The rationale for using IVUS-based surrogate end points in clinical trials is discussed in the present review. Key advantages of using IVUS-based surrogate end points versus clinical outcome include smaller patient numbers and substantially shorter trial durations; this reduces costs and may expedite the development and testing of new drugs. We expect in the near future a further increase of the use of IVUS-based surrogate end points in trials that evaluate novel CV therapies targeting on coronary atherosclerosis.

Abbreviations and Acronyms   CHD = coronary heart disease   CI = confidence interval   CSA = cross-sectional area   CV = cardiovascular   CVD = cardiovascular disease   %DS = percentage diameter stenosis   EEM = external elastic membrane   HDL-C = high-density lipoprotein cholesterol   HR = hazard ratio   IVUS = intravascular ultrasound   LDL-C = low-density lipoprotein cholesterol   MI = myocardial infarction

Related Article

Is Intravascular Ultrasound the Gold Standard Surrogate for Clinically Relevant Atherosclerosis Progression?

B. Greg Brown and Xue-Qiao Zhao
J. Am. Coll. Cardiol. 2007 49: 933-938. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				M. Hartmann, J. Huisman, D. Bose, L. O. Jensen, P. Schoenhagen, G. S. Mintz, R. Erbel, and C. von Birgelen Serial intravascular ultrasound assessment of changes in coronary atherosclerotic plaque dimensions and composition: an update Eur Heart J Cardiovasc Imaging, April 1, 2011; 12(4): 313 - 321. [Abstract] [Full Text] [PDF]

				D. B. Mark, D. S. Berman, M. J. Budoff, J. J. Carr, T. C. Gerber, H. S. Hecht, M. A. Hlatky, J. M. Hodgson, M. S. Lauer, J. M. Miller, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents J. Am. Coll. Cardiol., June 8, 2010; 55(23): 2663 - 2699. [Full Text] [PDF]

				WRITING COMMITTEE MEMBERS, D. B. Mark, D. S. Berman, M. J. Budoff, J. J. Carr, T. C. Gerber, H. S. Hecht, M. A. Hlatky, J. M. Hodgson, M. S. Lauer, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents Circulation, June 8, 2010; 121(22): 2509 - 2543. [Full Text] [PDF]

				C. von Birgelen and P. M.J. Verhorst Novel ultrasonic insight into coronary arteries Eur Heart J Cardiovasc Imaging, November 1, 2008; 9(6): 713 - 714. [Full Text] [PDF]

				S. H. Han, J. H. Bae, D. R. Holmes Jr, R. J. Lennon, E. Eeckhout, G. W. Barsness, C. S. Rihal, and A. Lerman Sex differences in atheroma burden and endothelial function in patients with early coronary atherosclerosis Eur. Heart J., June 1, 2008; 29(11): 1359 - 1369. [Abstract] [Full Text] [PDF]

				J. S. Rumsfeld and B. K. Nallamothu The Hope and Fear of Rimonabant JAMA, April 2, 2008; 299(13): 1601 - 1602. [Full Text] [PDF]

				B. G. Brown and X.-Q. Zhao Is Intravascular Ultrasound the Gold Standard Surrogate for Clinically Relevant Atherosclerosis Progression? J. Am. Coll. Cardiol., March 6, 2007; 49(9): 933 - 938. [Abstract] [Full Text] [PDF]