Technologies, Clinical Applications, and Implementation Barriers of Digital Twins in Precision Cardiology: Systematic Review

Cardiovascular digital twins show substantial potential to advance precision cardiology by linking personalized physiological models with clinical decision support, particularly for therapy planning and risk prediction in arrhythmia and heart failure. However, real-world implementation is constrained by methodological heterogeneity, restricted data and validation practices, limited openness of code and models, and sparse engagement with ethical and governance questions. Future research should prioritize standardized evaluation frameworks, robust clinical validation, interoperable and user-centered system design, and ethically grounded, patient-centered development to realize the full clinical value of digital twin systems.