1. To analyze the diagnostic and prognostic value of echocardiographic parameters.
2. Prediction of APE-related 30-day mortality and adverse out comes.
3. The need for rescue thrombolysis in initially normotensive Acute pulmonary embolism (APE) patients.

Acute pulmonary embolism (APE) is the most serious clinical presentation of venous thromboembolism (VTE). According to registries and hospital discharge databases of unselected patients with Acute pulmonary embolism and venous thromboembolism , 30-day all-cause mortality rates are between 9% and 10%.

According to the recent European Society of Cardiology (ESC) guidelines on the diagnosis and treatment of Acute pulmonary embolism patients, clinical classification of the severity of an episode of Acute pulmonary embolism is based on the estimated 30-day Acute pulmonary embolism - related mortality risk. Patients with cardiogenic shock caused by Acute pulmonary embolism comprise a high-risk group for early death, which is estimated at more than 15%.

Fortunately most Acute pulmonary embolism patients are hemodynamically stable at admission but the early mortality risk is different in this population. Risk stratification of non-high-risk Acute pulmonary embolism patients is based on clinical presentation, cardiac laboratory biomarkers, and signs of right ventricular (RV) dysfunction on echocardiography or computed tomography. Low-risk patients require a short hospital stay and can be early discharged home or even treated as outpatients.

Intermediate-risk subjects comprise a very heterogeneous group in which the early mortality ranges between 2% and 15%. More of these patients stabilize hemodynamically during anticoagulation, but in some of them clinical deterioration occurs and therefore they may require rescue thrombolysis or surgical or percutaneous embolectomy.

Echocardiography is a useful diagnostic tool to detected right ventricular (RV) dysfunction. It was reported that tricuspid annulus plane systolic excursion (TAPSE) can be used for risk stratification of normotensive APE patients. The tricuspid regurgitation peak gradient (TRPG) is an echocardiographic sign of RV overload and it can also be used for risk stratification in Acute pulmonary embolism .

Inclusion Criteria:

1. Age >18 and <70 years.

2. Patients with intermediate- risk pulmonary embolism will be

   1. -hemodynamically stable at admission with systolic blood pressure

      • 90 mmHg and without signs of peripheral hypoperfusion.

   2. - elevated cardiac biomarkers levels (particularly, a positive cardiac troponin test

Exclusion Criteria:

• 1- Age <18 years.

  2- Patients diagnosed with chronic thromboembolic hypertension.

  3- Patients with valvular heart diseases.

  4- Patients with lung cancer.

  5- Acute massive pulmonary embolism.

patients diagnosed with pulmonary embolism confirmed by contrast-enhanced multidetector computed tomography (MDCT) when thrombo-emboli were visualized