Baseline Echocardiographic Predictors of Outcomes in Low-to-intermediate Risk Acute Pulmonary Embolism and Integration with Electrocardiographic Findings: A Systematic Review and Meta-analysis.

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 Results: Thirteen studies ( 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.