In Reply

Letters to the Editor regarding the article Congestive Heart Failure Perioperative Risk Assessment and Therapeutic Consequences by Vera von Dossow, Giovanni Lurati Buse, Tau Hartikainen, Martin Mirus, and Johannes T. Neumann in issue 5/2026

We do not share Dr Huber’s perspective, as—in our opinion—it is too narrow and contradicts the established international guidelines (1). It is correct that perioperative cardiac decompensation makes for a poor prognosis—but this underlines the need for structured preoperative risk stratification, with echocardiography making an important contribution.

The European Society of Cardiology (ESC) explicitly does not recommend selective transthoracic echocardiography (TTE) as a screening modality in the context of preoperative evaluation, but in the following constellations (1):

• TTE should be considered in patients with newly identified cardiovascular risk factors and a high surgical risk (IIa recommendation)
• TTE may be considered in patients with cardiovascular clinical factors—for example, impaired resilience, an abnormal ECG, or raised NT-proBNP, and intermediate surgical risk (IIb recommendation)

The demand for risk adapted preoperative echocardiography is by no means unfounded actionism but is consistent with clear international guideline recommendations. In our article (2) we described a best-case scenario that certainly does not fully reflect the reality of healthcare in Germany. The article did, however, aim to raise awareness for the relevance of the subject.

As regards the comments on the three tables, Deutsches Ärzteblatt has already published a correction.

DOI: 10.3238/arztebl.m2026.0069

Prof. Dr. med. Vera von Dossow

Conflict of interest statement
The author reports that the Department for Anesthesiology at the NRW Bad Oeynhausen received a fee from Abbott in the context of a professional development workshop.

References

1. ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC). Eur Heart J 2023; 44: 4421

2. von Dossow V, Lurati Buse G, Hartikainen T, Mirus M, Neumann JT: Congestive heart failure: Perioperative risk assessment and therapeutic consequences. Dtsch Arztebl Int 2026; 123: 138–46