The future of imaging in cardiovascular disease intervention trials: 2017 and beyond

Purpose of review As our understanding of cardiovascular disease has advanced over the past decades, multiple novel treatment strategies have been developed with the hope of reducing the global morbidity and mortality associated with this condition. Large-scale trials to test such novel therapies using clinical end points are expensive, leading to interest in phase II clinical trials with imaging-derived outcome measures. Recent findings Noninvasive imaging techniques that assess changes in both atherosclerotic disease burden and plaque composition in response to therapy are well established. With the advent of molecular techniques and hybrid imaging, we now have the ability to assess disease activity alongside these standard anatomic assessments. This multifaceted approach has the potential to provide a more comprehensive assessment of the actions and efficacy of novel therapies in the carotids, aorta and coronary arteries. Summary This review will examine how advanced noninvasive imaging strategies have been used to investigate drug efficacy in intervention trials to date, and crucially how these approaches are set to evolve and play a central role in developing the next generation of atherosclerotic medication.