Routine Preoperative Echocardiography Before Noncardiac Surgery: Scoping Review with ☸️SAIMSARA

Name: SAIMSARA Evidence Object vascular::ECHO_BEFORE_SURGERY_SS
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara32c0f8b3

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Routine Preoperative Echocardiography Before Noncardiac Surgery: Scoping Review with ☸️SAIMSARA

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara32c0f8b3

Editorial note

• Last update: 2026-06-11 20:19:30

What is this paper about

Routine preoperative echocardiography before noncardiac surgery often adds little in unselected patients, with low actionable yield and weaker prediction than biomarkers such as NT-proBNP. The full read shows where echocardiography still matters, when stress echo or targeted TTE is justified, and how clinicians can move from routine imaging to smarter, risk-guided perioperative assessment.

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Abstract: This scoping review aims to systematically map and synthesize the available evidence on the utility, prognostic value, and clinical impact of routine preoperative echocardiography in adults undergoing noncardiac surgery, with a focus on its role in risk stratification, prediction of perioperative adverse events, and alteration of perioperative management compared to clinical risk indices and cardiac biomarkers. The review uses 72 references and builds its evidence map from 154 original studies with 5326296 total participants/sample observations (topic-deduplicated ΣN). The mapped evidence indicates that routine resting preoperative echocardiography in unselected noncardiac surgery populations yields a low prevalence of actionable findings (0.8–9%) and rarely alters perioperative management, while NT-proBNP consistently outperforms transthoracic echocardiography for predicting cardiovascular events (c-statistic 0.748 vs 0.579–0.589). Across study designs, the dominant signal supports a selective, biomarker-guided strategy rather than indiscriminate imaging, with stress echocardiography and targeted TTE reserved for higher-risk cohorts in whom specific findings independently predict mortality. The literature also highlights that more than one in four preoperative echocardiograms are ordered for rarely appropriate indications, reinforcing concerns about low-value care. Given the predominance of observational data, future randomized and de-implementation trials are needed to confirm whether a biomarker-first, selectively imaged pathway improves outcomes and resource use compared with routine echocardiography.
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Keywords: preoperative echocardiography; noncardiac surgery; perioperative risk stratification; transthoracic echocardiography; dobutamine stress echocardiography; major adverse cardiac events; left ventricular ejection fraction; diastolic dysfunction; mitral regurgitation; appropriate use criteria

Review Stats

Final search date and database lock: 2026-05-31 16:33:21 CEST
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 715
Downloaded Abstracts/Papers: 715
Included original and non-original Abstracts/Papers (all): 223
Included original Abstracts/Papers (Vote counting by direction of effect): 154
Reference Index (links used in paper): 72
Total participants/sample observations (topic deduplicated ΣN): 5326296

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Reference Index (72)

[1] Preoperative Transthoracic Echocardiography Predicts Cardiac Complications in Elderly Patients with Coronary Artery Disease Undergoing Noncardiac Surgery — https://doi.org/10.2147/cia.s369657
[2] Preoperative cardiac evaluation in elective non-cardiac surgery in India: Routine ECG, echocardiography, and angiography are not mandatory. — https://doi.org/10.1016/j.jham.2025.100321
[3] The Implication of Preoperative Transthoracic Echocardiography Evaluation in Patients with Hypertrophic Cardiomyopathy Undergoing Noncardiac Surgery by Anesthesiologists: Two Case Reports — https://doi.org/10.58888/2957-3912-2023-03-06
[4] Routine preoperative resting echocardiography does not predict adverse cardiopulmonary events after bariatric surgery. — https://doi.org/10.1016/j.soard.2021.01.021
[5] Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery. — https://doi.org/10.1016/j.echo.2019.11.015
[6] Preoperative cardiac abnormalities associated with one-year mortality in elderly patients undergoing hip fracture surgery: role of focused transthoracic echocardiography. — https://doi.org/10.1016/j.medcli.2025.107013
[7] Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography: Findings From the Mayo Poce-DSE Investigators. — https://doi.org/10.1016/j.amjmed.2017.12.025
[8] Predicting postoperative myocardial infarction in noncardiac surgery patients using explainable artificial intelligence — https://doi.org/10.1093/eurheartj/ehaf784.3588

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