Background <p>Myocardial remodeling is a key precursor to heart failure and adverse cardiovascular outcomes. While comorbidities such as hypertension, diabetes, and chronic kidney disease are prevalent in the geriatric population. Early identification of risk factors for myocardial remodeling could improve clinical outcomes in this population.</p> Methods <p>This retrospective study analyzed data from older patients (≥ 60 years) at Xiangya Hospital (<i>n</i> = 306). Clinical, echocardiographic, and biochemical data were collected, and myocardial remodeling was defined using standardized criteria. Multivariate logistic regression identified associated factors, which were incorporated into nomograms for left and right heart remodeling. Model performance was assessed using receiver operating characteristic curves, calibration plots, and decision curve analysis.</p> Results <p>The following factors were associated with myocardial remodeling: myocardiopathy, arrhythmia, valvular disease, PCI, diabetes mellitus, smoking history, male sex, renal function (including eGFR, urea, and uric acid), thyroid dysfunction, and albumin levels.</p> Conclusions <p>This study developed nomograms that provide a practical tool for early risk stratification, enabling targeted monitoring and intervention in the geriatric population.</p> Trial registration <p>The Ethics Committees at Xiangya Hospital, Central South University, accepted the study protocol with a waiver of informed consent (No. 2025060932).</p>