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

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.