Guidelines have not recommended routine echocardiography to predict perioperative cardiac events (PCE). We aimed to evaluate the prognostic significance of tissue Doppler echocardiography-derived E/E' for risk stratification before noncardiac surgery. We reviewed 445 consecutive patients with cardiovascular diseases who had undergone tissue Doppler echocardiography before noncardiac surgery. The revised cardiac risk index (RCRI) was assessed from clinical records. After excluding patients who could not have E/E' measurements, 200 patients were further analyzed. PCEs included death, arrhythmia, myocardial infarction, heart failure and deferred surgery. Eleven patients developed PCEs. E/E' was significantly higher in patients with PCE (18.4 ± 5.8 vs. 12.2 ± 4.5, p < 0.0005). Multivariate analysis showed E/E' (odds ratio 1.2, p < 0.007) and RCRI (OR 4.8; 95%, p < 0.006) were independent predictors of PCE. E/E' appeared to be useful in perioperative risk stratification among patients with cardiovascular diseases undergoing noncardiac surgery.