Background: The prediction of perioperative cardiovascular complications is important. Echocardiography is very useful screening test. Several indices have been developed, but a simpler, more practical and accurate method is needed. The purpose of this study was to determine whether the probrain natriuretic peptide (proBNP) concentration and echocardiographic parameter before operation can be used to predict perioperative cardiovascular complications in elderly patients undergoing noncardiac surgery Methods and Result: The study group is consist of 261 patients older than 60 years who were scheduled for elective surgery. Comprehensive echocardiography was performed. the plasma proBNP concentration and clinical cardiac indices were measured prior to operation. Cardiovasular complication occurred in 22 patients (8.4%). Age, the incidence of prior ischemic heart disease or congestive heart failure, more than intermediated risk operation , E/E', time of operation and the plasma proBNP concentration were significantly higher in patients with perioperative cardiovascular complications than in those without complication. However Hemoglobin was significantly lower in patients with complication. There was no difference of LAVI, EF, incidence of sex and diastolic function in two groups. Using receiver operating characteristic analysis to predict perioperative cardiovascular events, a cut-off value of 151pg/ml was identified as the optimal predictor of perioperative complications, showing a sensitivity of 81.8% and specificity of 77%. Multivariate analysis revealed that proBNP >150 pg/ml (95%confidence interval (CI) 0.18–0.414, p=0.002) were independent predictors for perioperative cardiovascular complications. Conclusions: Elevated proBNP levels are independently associated with an increase in the risk of perioperative cardiovascular complications in elderly patients undergoing noncardiac and nonvascular operations and Echocardiographic parameters (EF, LAVI, E/E', diastolic dysfunction) in not helpful predictor for perioperative cardiovascular complications.