Illuminating the Invisible: Translational Molecular Imaging in Cardiovascular Medicine

Cardiovascular disease remains the predominant cause of global morbidity and mortality, with recent epidemiological trends indicating a resurgence in adverse outcomes. Conventional imaging modalities-including coronary computed tomography angiography, echocardiography, and cardiac magnetic resonance imaging-are indispensable for anatomic and functional assessment, yet they lack the sensitivity to detect subclinical molecular perturbations that precede overt pathology. The advent of molecular imaging, leveraging nuclear, magnetic resonance, computed tomography, contrast-enhanced ultrasound, and photoacoustic platforms, enables in vivo visualization of disease-specific biological processes such as inflammation, metabolic dysregulation, and extracellular matrix remodeling. This review critically appraises the design and translational potential of molecular probes-including nanoparticles, antibodies, and peptides-focusing on their target specificity, pharmacokinetics, and clinical applicability. We further delineate the utility of molecular imaging in risk stratification and therapeutic monitoring across diverse cardiovascular pathologies, including atherosclerosis and plaque vulnerability, cardiac amyloidosis, inflammatory cardiomyopathies, and postinfarction remodeling. Finally, we discuss the integration of artificial intelligence and multiomics approaches in accelerating probe development and target validation, underscoring the paradigm shift toward mechanistically informed, precision cardiovascular medicine.