Optical theranostics in ischemic heart disease: from molecular insights to clinical translation.

Accurate risk stratification of ischemic heart disease (IHD) remains pivotal for mitigating associated global health burdens. Optical theranostics, combining imaging and therapeutic capabilities through light-based technologies, has emerged as a transformative strategy for IHD management. Advanced modalities mainly including optical coherence tomography, near-infrared fluorescence imaging, and photoacoustic imaging enable high-resolution visualization of coronary anatomy, myocardial perfusion, and molecular biomarkers. These modalities complement traditional cardiovascular imaging by providing real-time functional and molecular data with enhanced spatial resolution. Concurrently, phototherapy strategies such as image-guided photodynamic and photothermal therapies show therapeutic potential in preclinical studies. Integrated theranostic platforms now operationalize closed-loop workflows, where diagnostic imaging directly informs therapeutic parameters and monitors treatment response. While challenges persist in clinical translation-including tissue penetration limitations and safety optimization-ongoing developments in contrast agents, device miniaturization, and multimodal integration are accelerating practical applications. This review examines current progress in optical theranostics for IHD, analyzing technical principles, preclinical/clinical implementations, and translational barriers to optimize cardiovascular care through light-based technologies.