A number of studies reported in favor of the association between echocardiographic RVD and early adverse outcome (PE recurrence and mortality) in patients with acute PE (3-6). In-hospital mortality in PE patients with and without echocardiographic RVD has been found to be 18.4% and 5.7%, respectively, regardless of the hemodinamic status (3). In 126 patients with acute pulmonary embolism, Ribeiro et al. reported a 7.9% overall in-hospital mortality (7). Mortality was 14.3% in patients with severe RVD. In a cohort of 2454 unselected patients with acute pulmonary embolism included in the ICOPER registry, 2-week mortality was 15.9% in patients presenting with RVD in comparison to 8% in patients without RVD (8). In the MAPPET 10% of patients with RVD died within 30 days as compared to 4.1% of patients without (9). Recent data confirmed that patients with objectively confirmed PE, normal BP and echocardiographic evidence of RVD have a high incidence of adverse outcome and may potentially benefit from more aggressive treatment (10).