Background Acute pulmonary thromboembolism(APE)causes right ventricular dysfunction(RVD)and cardiactroponin Ⅰ(cTnⅠ)elevation.Patients with RVD and cTnⅠ elevation have a worse prognosis.Thus,early detection of RVDand cTnⅠ elevation is beneficial for risk stratification.In this study,we assessed 14-day adverse clinical events andcombined RVD on transthoracic echocardiography(TTE)with cTnⅠ in risk stratification among a broad spectrum of APEpatients.Methods The prospective multi-centre trial included 90 patients with confirmed APE from 12 collaborating hospitals.Acute RVD on TTE was diagnosed in the presence of at least 2 of the following:right ventricular dilatation(withouthypertrophy),loss of inspiratory collapse of inferior vena cava(IVC),right ventricular(RV)hypokinesis,tricuspidregurgitant jet velocity>2.8 m/s.The study patients were divided into two groups according to clinical andechocardiographic findings at presentation:Group Ⅰ:50 patients with RVD;Group Ⅱ:40 patients without RVD.Results More than half of the patients(50/90,55.6%)had RVD.Nearly one third(26/90,28.9%)of patients hadelevated cTnⅠ at presentation and only 4.2% on the fourth day after initial therapy.A multiple Logistic regression modelimplied RVD,right and left ventricuiar end-diastolic diameter ratio(RVED/LVED),and cTnⅠ independently predict anadverse 14-day clinical outcome(P<0.01).Receiver operating characteristics(ROC)curves revealed that the cut-offvalues of RVED/LVED and cTnⅠ yielding the highest discriminating power were 0.65 and 0.11 ng/ml,respectively.Furthermore,the incidence of an adverse 14-day clinical event in patients with RVD and elevated cTnⅠ was greater(40.7%)than in patients with elevated cTnⅠ or positive RVD alone(0% and 8.3%,respectively)(P<0.001).Conclusions RVD,RVED/LVED,and cTnⅠ are independent predictors of 14-day clinical outcomes.The patients withRVED/LVED greater than 0.65 and cTnⅠ higher than 0.11 ng/ml at presentation possibly have adverse 14-day events.RVD combined with cTnⅠ can identify a subgroup of APE patients with a much more guarded prognosis. Background Acute pulmonary thromboembolism (APE) causes right ventricular dysfunction (RVD) and cardiactroponin I (cTnI) elevation. Patients with RVD and cTnI elevation have a worse prognosis. Thus, early detection of RVD and cTnI elevation is beneficial for risk stratification.In this study , we assessed 14-day adverse clinical events and combined RVD on transthoracic echocardiography (TTE) with cTnI in stratification among a broad spectrum of AP Patients. Methods The prospective multi-center trial included 90 patients with confirmed APE from 12 collaborating hospitals. Acute RVD on TTE was diagnosed in the presence of at least 2 of the following: right ventricular dilatation (withouthypertrophy), loss of inspiratory collapse of inferior vena cava (IVC), right ventricular (RV) hypokinesis, tricuspidregurgitant jet velocity> 2.8 m / s. study patients were divided into two groups according to clinical andechocardiographic findings at presentation: Group Ⅰ: 50 patients with RVD; Group Ⅱ: 40 patien had more than half of the patients (50/90, 55.6%) had RVD. Nearly one third (26/90, 28.9%) of patients with hadelevated cTnI at presentation and only 4.2% on the fourth day after initial therapy .A multiple Logistic regression modelimplied RVD, right and left ventricuiar end-diastolic diameter ratio (RVED / LVED), and cTnI independent predict anadverse 14-day clinical outcome (P <0.01). Receiver operating characteristics (ROC) curves revealed that the cut -offvalues ​​of RVED / LVED and cTnI yielding the highest discriminating power were 0.65 and 0.11 ng / ml, respectively. Frther and the incidence of an adverse 14-day clinical event in patients with RVD and elevated cTn I was greater than (40.7%) than in Patients with elevated cTnI or positive RVD alone (0% and 8.3% respectively) (P <0.001) .Conclusions RVD, RVED / LVED, and cTnI are independent predictors of 14-day clinical outcomes.The patients with RVED / LVED greater than 0.65 and cTnI higher than 0.11 ng / ml at presentation possibly have adverse 14-day events.RVD combinedwith cTnI can identify a subgroup of APE patients with a much more guarded prognosis.