AIMS: Patients suspected of acute pulmonary embolism (PE) frequently undergo echocardiography as a part of the initial work-up. Prognostic implication of routine echocardiography in patients suspected of PE remain to be established. METHODS AND RESULTS: Transthoracic echocardiography, including tissue Doppler imaging, was performed in 283 consecutive patients referred for ventilation/perfusion scintigraphy (V/Q scan) on suspicion of first non-massive PE. The prognostic information of quantitative measures of right ventricular (RV) size, function, and pressure was assessed. Patients with PE had a follow-up echocardiography after 1 year and changes in the parameters were assessed. Patients with PE and normal V/Q scans had similar age-adjusted 1 year mortality [10 and 12%, NS (not significant)], although patients with indeterminate scans carried a poorer prognosis (16% survival, P=0.0004). Among all patients left ventricular (LV) ejection fraction as well as shortening of the pulmonary artery (PA) acceleration time (a measure of RV after-load) was associated with increased mortality [hazard ratio (HR)=0.84 per 10 ms increase, P<0.0001]. In patients with confirmed PE, the PA acceleration time is predictive of event-free survival (all-cause mortality and heart failure hospitalizations) adjusted for LV ejection fraction, age, and sex (HR=0.78 per 10 ms increase, P=0.04). Measures of regional myocardial function were not related to outcome in this study, regardless of presence of PE. CONCLUSION: PA acceleration time and LV systolic function are independent predictors of mortality in patients suspected of PE, and are independent predictors of event-free survival in patients with confirmed PE.