Background and Objectives Although non-stress echocardiography is widely performed as preoperative screening before noncardiac surgery, its predictive power for postoperative cardiac complication is not well shown. We investigated whether echocardiographic findings could identify patients at high risk for postoperative cardiovascular events after elective noncardiac surgery. Methods and Results We enrolled 1,113 patients (age 64짹11 year, male 64%) who were referred for cardiovascular risk evaluation before elective noncardiac surgery and underwent Doppler echocardiography within 3 months. Patients with significant mitral valvular heart disease or who were not suitable for tissue Doppler analysis were excluded. Clinical preoperative cardiovascular risk was assessed using the Revised Cardiac Risk Index (RCRI).Postoperative major adverse cardiovascular events (MACE) were defined by cardiac death, myocardial infarction, or aggravation of congestive heart failure within postoperative 72 hours.Postoperative MACE occurred in 97 patients (8.7%). Receiver-operating characteristic (ROC) analysis showed that any echocardiographic parameters (AUC=0.618) could not reach comparable predictive power to RCRI (0.677). Subgroup analysis revealed that LAVI (AUC=0.683) and E/e` (0.727) was more predictive for MACE than RCRI (0.573) in patients younger than 60 years (Table 1). Conclusions Routine preoperative Doppler echrocardiography adjunct to clinical evaluation added little value for the prediction of postoperative MACE after noncardiac surgery. However, it might have a role in young age subgroup in which RCRI was less predictive than old age subgroup.