Abstract
BACKGROUND: Acute pulmonary embolism (APE) is a cardiovascular emergency with considerable morbidity and mortality. Echocardiography has been an essential tool for risk stratification in high-risk patients. However, its prognostic utility in low-to-intermediate risk cases remains underexplored. Electrocardiographic (ECG) findings may provide additional prognostic information but are infrequently assessed alongside echocardiography. OBJECTIVE: To assess the prognostic value of baseline echocardiographic parameters in low-to-intermediate risk APE and to examine ECG findings as complementary tools in risk stratification. METHODS: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Literature searches were performed in Medline, Scopus, Google Scholar, and Semantics up to December 2024. Studies enrolling adult patients with confirmed APE categorized as low-to-intermediate risk classification were included. Primary outcomes were in-hospital mortality or clinical deterioration. Pooled estimates were analysed using fixed-or random-effects models, or analysis of P values. RESULTS: Thirteen studies (n = 3073) were included. Echocardiographic parameters significantly associated with adverse outcomes included reduced tricuspid annular plane systolic excursion, RV fractional area change, and elevated pulmonary artery systolic pressure and tricuspid regurgitation velocity. ECG findings of T wave inversion and ischemic ST changes are strongly correlated with RV dysfunction and increased pulmonary pressures, supporting their adjunctive prognostic value. CONCLUSION: In low-to-intermediate risk APE, echocardiographic indicators of RV dysfunction and pulmonary pressure are predictive of adverse outcomes. ECG findings were correlated with echocardiographic abnormalities and may enhance risk stratification, especially in resource-limited settings.