What question did this study set out to answer?

This review aims to summarize current evidence and guidelines surrounding the use of transthoracic echocardiography before non-cardiac surgeries.

June 19, 2026Journal of Clinical Monitoring and Computing0 citationsOpen Access

Echocardiography before non-cardiac surgery: current knowledge, guideline recommendations, and clinical evidence – a narrative review

Q: What is the clinical evidence from this study?

Study design: Review. Population: Patients undergoing non-cardiac surgery. Intervention: Preoperative transthoracic echocardiography (TTE) or focused cardiac ultrasound (FOCUS) vs. No preoperative echocardiography / routine care.

VMViktoria MertinDüsseldorf University Hospital ASAlexandra StrodaDüsseldorf University Hospital TBTobias BrunsCarl von Ossietzky Universität Oldenburg

Key Result

Preoperative echocardiography before non-cardiac surgery detects new diagnoses and triggers management changes, but evidence demonstrating improved perioperative outcomes remains limited and inconclusive.

Key Points

This review aims to summarize current evidence and guidelines surrounding the use of transthoracic echocardiography before non-cardiac surgeries.
Conducted a narrative review of existing literature on preoperative transthoracic echocardiography.
Assessed recommendations from professional societies including the American Heart Association and European Society of Cardiology.
Identified knowledge gaps related to management changes and clinical outcomes following TTE.
Preoperative TTE can detect new diagnoses in a significant number of patients, though studies are limited.
Evidence regarding the impact of TTE findings on management changes is scarce.
Outcome benefits from preoperative TTE are not conclusively demonstrated, highlighting the need for further research.

Structured PICO

Does preoperative transthoracic echocardiography (TTE) impact management and outcomes in patients undergoing non-cardiac surgery?

Population

A narrative review evaluating the utility, management changes, and outcome impact of preoperative transthoracic echocardiography in patients undergoing non-cardiac surgery.

Intervention

Preoperative transthoracic echocardiography (TTE) at rest

Outcome

Detection of new diagnoses, TTE-driven management changes, and outcome impact

This review highlights that while preoperative TTE detects new diagnoses, there are significant knowledge gaps regarding its impact on clinical management and postoperative outcomes in non-cardiac surgery.

Limitations

Evidence is limited in quantity and certainty, with many studies being single-center with small sample sizes.
Data on the outcome impact of TTE relies largely on administrative data and suffers from residual confounding.
The few available randomized trials evaluating outcome impact were non-conclusive and underpowered.
Studies differ greatly with regard to the use of TTE and FOCUS, limiting comparability.

Abstract

This narrative review provides an overview of the evidence on transthoracic echocardiography (TTE) at rest in patients undergoing non-cardiac surgery with regard to detection of new diagnoses, TTE-driven management changes, and outcome impact of preoperative TTE. It summarizes the evidence on preoperative TTE and reviews the current recommendations by professional societies from both Europe and Northern America. TTE is a very important non-invasive diagnostic tool to obtain information on cardiac function before surgery. While studies on the effectiveness of preoperative TTE are limited, there is evidence that TTE before non-cardiac surgeries can detect new diagnoses in a relevant proportion of patients. Also, data on changes in management based on TTE findings is scarce. Both the American Heart Association and the American College of Cardiologists and the European Society of Cardiology have recently published updated recommendations regarding the use of TTE before non-cardiac surgery. While both societies are in favour of TTE in symptomatic patients and do not recommend TTE to be performed routinely, several differences remain. Information on outcome benefits in patients having received TTE prior to surgery is not conclusive. In this review we could detect several knowledge gaps concerning the yield and impact on management and outcome of preoperative TTE in non-cardiac surgery patients.

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