Noninvasive Testing for Diagnosis of Stable Coronary Artery Disease in the Elderly

Abstract

Efficient diagnostic approaches to detect coronary artery disease (CAD) in elderly patients are necessary to ensure optimal and timely treatment. The population of suspected CAD patients older than 70 years is especially vulnerable and constantly growing. Finding the optimal diagnostic approach is challenging due to certain features of this population, such as high prevalence of comorbidities, existing contraindications to exercise tests or cognitive decline, which hinders correct assessment of the patient’s situation. Moreover, some symptoms of CAD can have variable significance in the elderly compared to younger adult groups. In this review, we present current recommendations of the United States (US) and European cardiologists’ associations and discuss their applicability for diagnostics in the elderly population. Exercise electrocardiogram (ECG) and exercise stress echocardiography (SE) tests are not feasible for a substantial proportion of elderly patients. Coronary computed tomography angiography (CTA) appears to be an attractive alternative for such patients, but is not universally applicable; for instance, it is problematic in patients with significant calcification of the vessels. Moreover, more studies are needed to compare the results delivered by CTA to those of other diagnostic methods. Future efforts should be focused on comparative studies to better understand the limits and advantages of different diagnostic methods and their combinations. It is possible that some of the currently used diagnostic criteria could be improved to better accommodate the needs of the elderly population.

Atrial fibrillation is a predictor of nonobstructive coronary artery disease in elective angiography in old age: a cross-sectional study in Poland and Russia

“…The decision to conduct cardiac catheterization after noninvasive test results indicate a high risk of significant coronary vessel changes improves the effectiveness of coronary angiography [ 14 , 20 ]. However, stress testing before the intervention is significantly less often performed in the older age group, and older patients less often show objective signs of ischemia [ 40 ].The traditional stress test is often inconclusive in AF, and the frailty of patients with AF is an additional obstacle that limits the possibility of performing stress tests [ 38 , 41 ]. Because of the possibility of triggering an episode of AF, dobutamine stress ECHO is not considered as the primary alternative [ 42 ].…”