Noninvasive Cardiac Imaging in Older Adults: Diagnostic Challenges and Prognostic Implications Across Modalities

Area of Science:

• Cardiology
• Geriatric Medicine
• Medical Imaging

Background:

• Older adults present unique challenges for cardiovascular disease diagnosis due to multimorbidity and age-related changes.
• Noninvasive cardiac imaging is crucial for diagnosis and risk stratification in this population.
• Clinical heterogeneity and physiological changes in aging necessitate careful consideration of imaging modalities.

Purpose of the Study:

• To review the strengths and limitations of common noninvasive cardiac imaging modalities in older adults.
• To highlight diagnostic challenges specific to geriatric cardiovascular assessment.
• To discuss the role of technological advancements and tailored test selection in improving care.

Main Methods:

• Review of commonly used noninvasive cardiac imaging modalities: echocardiography, transesophageal echocardiography, cardiac computed tomography, nuclear imaging, and cardiac magnetic resonance imaging.
• Analysis of diagnostic challenges in older adults, including limited exercise capacity and image quality issues.
• Exploration of advances in imaging technology, such as AI and hybrid protocols.

Main Results:

• Common imaging modalities have specific strengths and limitations in the context of aging.
• Diagnostic accuracy can be affected by factors like multivessel disease, microvascular disease, and intolerance to scan protocols.
• Technological advancements offer potential for enhanced accuracy and personalized decision-making.

Conclusions:

• Selecting the appropriate imaging test based on patient comorbidities and goals of care is paramount.
• Addressing evidence gaps through geriatric-focused trials and guidelines is essential for equitable cardiovascular care.
• Tailored, high-value cardiovascular care for older adults requires optimized noninvasive imaging strategies.