Dear Colleagues,

Coronary artery disease (CAD) remains a significant global health concern, with a substantial impact on morbidity and mortality. Timely and accurate diagnosis, as well as effective management strategies, are essential to mitigate the burden of CAD. The early diagnosis of CAD is hindered by the asymptomatic nature of the disease in its early stages. Left under-recognized and untreated, these cases have a worse prognosis than that of healthy counterparts. Patients may remain unaware of their condition until symptoms occur. Quite often they are late and nonspecific if present at all. Identifying individuals at a high risk of CAD and performing timely interventions are crucial to preventing adverse outcomes. Current methods for early CAD diagnosis are revolutionizing the concept of myocardial ischemia.

Advanced non-invasive imaging techniques, including coronary computed tomography angiography (CCTA), with or without functional assessment, cardiac magnetic resonance imaging (MRI), and perfusion scintigraphy, offer new and still underused diagnostic benefits for patients in the early stages of coronary artery disease. In addition to imaging biomarkers, new biochemical and molecular biomarkers become available, which makes possible the generation of multimodality early CAD scoring protocols for early detection and prognostication. On the other hand, invasive diagnostic procedures with the functional evaluation of epicardial and microvascular coronary artery disease play a pivotal role in the precise diagnosis and management of patients with CAD.

This Special Issue will delve into the latest approaches for the early identification of patients with CAD and their risk stratification. We will discuss the efficacy, cost-effectiveness, and challenges associated with new imaging modalities, as well as their possible combination with non-imaging (biochemical, molecular) and functional diagnostic methods. This Special Issue aspires to provide clinicians, researchers, and healthcare professionals with a comprehensive understanding of the evolving landscape of the early diagnosis and management of coronary artery disease. By addressing the gaps in the current methodology of early CAD detection, proper diagnosis, challenges to treatment, best practices, and innovations in this field, we aim to contribute to the improved care and outcomes of CAD patients worldwide.

Dr. Dobrin Iotkov Vassilev
Dr. Niya Boykova Mileva
Guest Editors

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• coronary artery disease
• microvascular disease
• ischemia